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  1. #1
    Default 72295
    Exam Training Packages
    Good morning!

    I have a claim that is denying from work comp for 72295 w/26 modifier.
    They state that 26 mod is incorrect or no longer valid. This was billed for the physician charges. Thanks

  2. #2
    North Carolina
    Unless something has changed, there is a CPT Assistant (April 2003) that supports this.

    If the physician performed only the professional component of the diskography, then mod.26 should be appended to code 72295 to indicate this circumstance.

  3. #3
    (These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

    Work Comp does not always follow the 'rules'. Please contact your state Work Comp agency and query them, or take the -26 off and resubmit.

    Richard Mann, your pain management coder

  4. Default
    I agree with Richard, we have WC payers who were still using old CPT codes on their fee schedules years after they had been deleted... If the mod isn't on their fee schedule they won't pay it.

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