Blackhorse
Guru
Our ASC claim for 64493 on UB-04 is denied by Medi-Cal because of missing correct modifiers. What surgical modifiers that Medi-Cal is looking for?
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Wiki Surgical modifier with Medi-Cal
- Thread starter Blackhorse
- Start date
SharonCollachi
Guest
Have you looked through the approved Medi-Cal modifier list? Here: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwj_58fRy73xAhWH4J4KHRH-CRgQFjAAegQIBBAD&url=https://files.medi-cal.ca.gov/pubsdoco/Publications/masters-MTP/Part2/modifapp.pdf&usg=AOvVaw2greuQTrpu9EQVdjABzQqt
Here is another document specifically for surgical modifiers and Medi-Cal: https://www.google.com/url?sa=t&rct...rgmod_io.pdf&usg=AOvVaw0qxNpOvJEgVyNT7mnUJYwH
Here is another document specifically for surgical modifiers and Medi-Cal: https://www.google.com/url?sa=t&rct...rgmod_io.pdf&usg=AOvVaw0qxNpOvJEgVyNT7mnUJYwH
Blackhorse
Guru
I reviewed the list and modifier 54 looks good to me but my colleague wants to try AG. I think AG is only for CM-1500 not for UB-04.
thomas7331
Guest
Better to contact the payer to find out what they're looking for rather than 'trying' different modifiers. It may just have been a mistake on their part, or there could be a specific reimbursement policy that they're requiring you to follow that they could direct you to.
SharonCollachi
Guest
Medi-Cal does have a help desk, but the quality of help is... "meh" at best.
I had an issue where my claims for comprehensive inpatient rehab hospital/physician services were being denied for POS. The correct POS is 61, but Medi-Cal didn't like that. The specialist assigned to help me wasn't of any help, and she couldn't figure it out either. I finally asked her, in writing so I would have backup in case of audit, if I should bill with POS 21 (hospital) and modifier U2, and she said, basically, to give it a try. My claims are now all paying, but if we ever get audited, I have the email to back up what we're doing.
The Medi-Cal manual was unclear on my issue; it did say services were covered though, so we didn't feel we were doing anything wrong by billing POS 21.
Blackhorse
Guru
I billed the claim with modifier AG, I'll let you know once we got paid or denied.
DGDONNA
Contributor
I am new at this, but maybe RT / LT.