Wiki Helppp!!! Denial for missing modifier for CPT code 37236

Provider placed a stent in the superior mesenteric artery for one patient and for another patient a stent in the Celiac artery. CPT code 37236 was used. However, Humana is denying the claims stating missing modifier. All other line items were paid. Codes used were 37236; 75726,26,59; 36245. I have appealed the claims with supporting documents but still keep getting a denial for that code. I checked the code on Novitasphere and a 26/TC modifier is not required for that code. So I am not sure what modifier I am to use in this situation I would be grateful if someone could provide information on how to correctly code for this procedure.

Use either a RT or LT modifier.

That's what I was thinking and verified with the provider and was told that neither the celiac nor the sma has a left or a right. It is just one single artery. I sent an appeal letter stating just that and it was still denied.

I'm with you, however that is what the third-party payers want. Just add a modifier and everyone is happy.
Good luck

I'm having this same issue with Humana. Since the celiac nor the SMA have a left or right, and Humana is insisting on having one of those, would we be correct to add the modifier based on access point? For example, if they accessed through the right groin, should we add a RT to 37236? These denials are insane

Aetna and Cigna's automated pre-screening has been active since January and is hitting modifier-heavy claim types hard. For CPT 37236 specifically, the issue is almost always the modifier stacking pattern triggering an automated edit, not a clinical judgment call.

The important distinction with AI-generated technical denials is that they have a separate appeal pathway from standard clinical denials. When you file through the wrong track, you end up making a medical necessity argument when the actual dispute is that the automated logic was incorrectly applied to a correctly coded claim. The framing, the documentation, and the overturn rate are all significantly different when you get it right.

For CPT 37236 modifier denials, the appeal package that gets results includes the operative report with highlighted modifier justification sections, a modifier usage rationale letter from the provider, and explicit language stating that you are disputing an automated edit, not requesting clinical review. That last piece is what changes which department reviews your appeal.

I built the EDI Lab at roithatworks.com/edi-lab.php to help practices work through exactly this kind of denial. You look up the CARC and RARC codes from your denied claims and it tells you what they mean, the root causes behind them, and appeal tips for that denial category. The free sample account gives you 5 lookups per session, and my platform also includes a Bundling and Modifier Issues appeal template with CPT Assistant references, CCI edit guidance, and modifier justification language built specifically for this denial type.