Example would be:
1) Pt had lab services done for UA reflex w/ culture, and non-gyn cytology, we billed to Medicare with Dx code N390 and CPT code used 88173 used with modifier 90. (CPT is under physician fee schedule) denial was for CPT 88173.
2) Pt had lab services for CMP, lipid, cbc w/ diff, (immunoassay, Analyte - used modifier 90), (Immunossay, Qunt, RIA - used modifier 59) and (Anti striated muscle AB - used modifier 90). CPT's for all labs used are 80053, 80061, 85025, 36415, 83519, 86255. We billed to Medicare primary and pt also has BCBS secondary.
Denial was for CPT 83519.
Both the claims got rejected with denial code N104 (this claim/service is not payable under our claims jurisdiction area. you can identify the correct medicare contractor to process this claim/service through the CMS website cms.gov)
Thank you