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Wiki Help with Modifier for cpt 61635 & 61630

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lneely

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Local Chapter Officer
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Location
Lenoir City, TN
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We recently got a new Medicare MAC which is Palmetto. I am now getting denials for cpt 61630 & 61635 stating I am missing a required modifier. This wasn't required with our old MAC. I've talked to Palmetto several times to no avail as to where to look for the appropriate modifier. I know these are restricted codes, but I'm at a loss of which modifier I need. Any help would be greatly appreciated.

Thanks,

Lori Neely, CPC
 
Resolution?

Hi,

I am wondering if you ever found out what the missing modifier was? I have the exact same denial for 61630 billed with 36225 and 75898-26. Optum does not show any NCCI conflicts for any of these codes to be billed together and no other services were provided same day. I also do not see an NCD or LCD for this code so I am at a complete loss.

Thank you!
 
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