NCCI Edits on Aspheric Lens- Modifier Question

SRCoding

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Hi,

We received a denial from MO Medicaid for Aspheric (V2430) billed with BF (V2211). When we call Medicaid they say its an NCCI edit and it requires a modifier to override it. They've paid for Aspheric with other BF lenses (V2201, V2207) and V2700. This particular patient had a balance lens V2700 for the left billed with Aspheric V2430 and both paid but the right Aspheric denied billed with V2211. I see that the combination is on the MUE report and it does indicate a modifier is allowed..

Can anyone shed some light on this for me? We don't understand why a low prescription bifocal and balance lens billed with Aspheric pays but a high prescription BF does not. Also, which modifier is appropriate to use and what are the requirements to use it?

Thank you!

Stephanie K
 
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