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Wellcare denial due to Modifier

  1. Default Wellcare denial due to Modifier
    Medical Coding Books
    I am newer to Gastro billing and I have a claim that was denied by Wellcare because we used the SG modifier. This is for a facility fee in the ASC. Does anyone know what modifier I should be using instead of the SG? Thank you for your help!!!

  2. Smile
    Medicare discontinued the -SG modifier in 2009, I think. Apparently your (new at that time) NPI would let the payers know you are billing facility fees for the codes on the claims, not professional fees.

    That being said - we still have to use the -SG modifier for a number of payers that still demand it - so check with your payers.

    Hope this helps.

  3. Default

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