Wiki Wellcare denial due to Modifier

[LRoethlisb]

I am newer to Gastro billing and I have a claim that was denied by Wellcare because we used the SG modifier. This is for a facility fee in the ASC. Does anyone know what modifier I should be using instead of the SG? Thank you for your help!!!

 

[nsteinhauser]

Medicare discontinued the -SG modifier in 2009, I think. Apparently your (new at that time) NPI would let the payers know you are billing facility fees for the codes on the claims, not professional fees.

That being said - we still have to use the -SG modifier for a number of payers that still demand it - so check with your payers.

Hope this helps.

 

[LRoethlisb]

Thanks!!!