When I am billing Medicaid of North Carolina they are paying code 64483 as prime and denying 64484 as inclusive. Does anyone know of any modifiers I could use to get this paid? I am thinking a 59? Thanks
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Wiki 64483 and 64484 modifier?
- Thread starter priceam
- Start date
RebeccaWoodward*
True Blue
What was the denial code? NC Medicaid had erroneous denial issues with the other codes within this section.
Attention: All Providers
CPT Codes 64490, 64491, 64492, 64493, 64494, and 64495
Claims billed with CPT procedure codes 64490 through 64495, in the office setting, for dates of service January 1, 2010, and after, were incorrectly denied. Changes have been applied to the system and providers who received a denial with EOB 36 may now resubmit the denied charges as new claims (not adjustments) for processing.
We constantly receive denials for modifier issues. Appeals are frequent with this carrier and paid in most instances. Their request for unconventional modifier use is tiresome.
Attention: All Providers
CPT Codes 64490, 64491, 64492, 64493, 64494, and 64495
Claims billed with CPT procedure codes 64490 through 64495, in the office setting, for dates of service January 1, 2010, and after, were incorrectly denied. Changes have been applied to the system and providers who received a denial with EOB 36 may now resubmit the denied charges as new claims (not adjustments) for processing.
We constantly receive denials for modifier issues. Appeals are frequent with this carrier and paid in most instances. Their request for unconventional modifier use is tiresome.
I bill for Nevada Medicaid and they want modifier 51 used for any procedure after the primary even though 51 is not an approved modifier for ASC's but that's what they want and our claims get paid so maybe try calling them and seeing if they would accept it.
Good luck!
Susan, CPC-H
Good luck!
Susan, CPC-H
dwaldman
True Blue
It is unlikely that a Medicare carrier is going to need a NCCI modifier such as 59 on an add on code which is billed with the corresponding primary procedure. I limit the use of the 59 with code pairs that have CCI Edits and the modifier meets the criteria in that situation (eg separate site treated) Anytime you are getting denials that seem incorrect with Medicare, I always focus on trying to find out; if indeed, it is a system error and when they anticipate it being fixed.