Now, just because it doesn't need a modifier to be payable, doesn't mean that payers must cover it. Many don't. Take a look at this coverage policy by United Healthcare: https://www.unitedhealthcareonline.c...icies/AH_After Hours_v2011A.htm
As long as they disclose their payment policy, they have a basis for denial. You can certainly try to appeal it, but you're facing an uphill battle. Nothing you change about the way that you billed it should make any difference, if the denial is correct. And if they are requesting special treatment, find every piece of literature you can that supports the way that you billed it, and appeal their unreasonable request. That would place an unnecessary hardship on your coders and billers, since all other payers recognize CPT guidelines and expect you to bill according to the standard rules - some patients are bound to be double-covered. Then what? Hope that helps!
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