Wiki Q9966????

[Jennifer Edmondson]

Hello Everyone,
I have a question about Q9966. Low osmolar contrast material. We use this with injections in our ASC center. Blue Cross is wanting a modifier!? A 26 modifier. Can anyone expalin why this is? I s anyone else having problems with this???

 

[mbort]

here is the modifier cross walk. I've never used the code so I'm not familiar with the requirementsj so maybe this would help. (my guess is the KX perhaps?)

Modifier Description
99 Multiple Modifiers
CR Catastrophe/Disaster related
FB Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples)
GK Reasonable and necessary item/service associated with GA or GZ modifier
GL Medically unnecessary upgrade provided instead of nonupgraded item, no charge, no advance beneficiary notice (ABN)
GZ Item or service expected to be denied as not reasonable and necessary
KX Requirements specified in the medical policy have been met
QJ Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 CFR 411.4(B)

 

[jira85]

Nope- I haven't had this denial before- and we use Q9966 with Anthem BCBS alot. Still, they don't pay much on it anyways.