Wiki Claim denial modifier assistance

[calorom2]

Hoping someone can assist with this. Florida Blue is denying claims with these codes billed stating a modifier is needed. These were performed in the office place of service and have always paid billed as is in the past. Anyone have any thoughts or suggestions?

A9555 2 units
J2785 4 units
78492 1 unit
93015 1 unit
78434 1 unit

Thank you!

 

[vidraj]

Hello, did you get this resolved?
We are currently having issues with both A9555 and A9502.The tests are performed at office and being billed with the codes below.
But having problem with one Payer (Banner Medicare) who is denying just the A9555 stating that " CPT A9555 is denied as Separately billed services/tests have been bundled as they are considered components of the same procedure."
A9555 x 2 units - denied.
J2785 x 4 units
78431 x 1 unit - TC
93015 x 1 unit
78434 x1 unit - TC

The same with the A9502 as well when submitted with the below set of codes.
78452 x 1 unit
J2785 x 4 units
A9502 x 2 units - denied.
93015 x 1 unit
Can someone help with any suggestions on what are we missing here?

 

[bmil]

Hello, did you get this resolved?
We are currently having issues with both A9555 and A9502.The tests are performed at office and being billed with the codes below.
But having problem with one Payer (Banner Medicare) who is denying just the A9555 stating that " CPT A9555 is denied as Separately billed services/tests have been bundled as they are considered components of the same procedure."
A9555 x 2 units - denied.
J2785 x 4 units
78431 x 1 unit - TC
93015 x 1 unit
78434 x1 unit - TC

The same with the A9502 as well when submitted with the below set of codes.
78452 x 1 unit
J2785 x 4 units
A9502 x 2 units - denied.
93015 x 1 unit
Can someone help with any suggestions on what are we missing here?

We are having a similar problem with one regional payer. BSW created a new McrAdv plan for 2024 (we didn't have this problem with the old one) and they are denying the A9555 with CO16 (need info); claim remark code M119 (NDC incorrect). But also denying 78431 and 78434 with no explanation at all. They paid 93015 and J2785. We verified the NDC and the other Medicare Adv and regular Medicare are not doing this. I think they loaded something wrong in their edits. We are trying to get the rep to help us because so far their claims people just see "NDC" and tell us it must be wrong or to just send records with an appeal. We are not billing with -TC as we did the full service in our office.