50, QW, RT LT modifers for BCBS

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4
Location
OAK RIDGE, TN
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So all my procedures and pregnancy tests are being rejected by my clearing house :
Using 50 modifier: 64494 Acknowledgement/Rejected for Invalid Information-The claim/encounter has invalid information as specified in the Status details and has been rejected - Procedure Code Modifier(s) for Service(s) Rendered (64494)
Using QW: 84703 Acknowledgement/Rejected for Invalid Information-The claim/encounter has invalid information as specified in the Status details and has been rejected - Procedure Code Modifier(s) for Service(s) Rendered (84703)
On the 64494 codes I split them up RT and LT still they are rejecting....
Is anyone else having this issue now?? How did you fix it?
 

Deborah Marsh

Contributor
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11
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The lab code accepts QW according to Medicare's CLFS. Could the payer have a different policy or a claim requirement for supporting use of that modifier? For +64494, the CPT guidelines say you can use mod 50 with the primary codes, but report add-on code +64494 "twice, when performed bilaterally. Do not report modifier 50." You mentioned you had split the reporting on to separate lines, though, so it sounds like even following that rule didn't work. The message didn't say a primary code was missing, so I assume that primary code was reported. The MPFS does allow +64494 to be reported bilaterally, but perhaps there's a payer-specific policy in play.
 
Messages
4
Location
OAK RIDGE, TN
Best answers
0
So I finally found an answer.. I had been billing them out correctly BUT BCBS had a glitch as of the New Year. They said that got it corrected with CMS and to resubmit any rejections on 1.26.2021
Thank you for your help :)
 
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