denial/looking for mocifier

I have been getting denials on my claims for Renal Panels done in our in-house laboratory. They are asking for a modifier. Can anyone tell me what modifier they are looking for?

re: denial/looking for mocifier

80069 is a CLIA waived test so depending on the payer they could be looking for a QW modifier.

Hope that helps, Mary

re: denial/looking for mocifier

It sounds like the patient may have ESRD- either your office or another provider submitted this diagnosis. A patient becomes automatically enrolled in MCR, regardless of age once the receive this diagnosis. Once they receive a transplant they remain on it for a short time period afterwards (depending on their age). CMS has several publications to help with this. The insurance is looking CD,CE or CF mods for dos on or before 12/31/10 or AY effective 01/01/11. They want the panels unbundled with the appropriate mod assigned. See your local carrier's policies on these mods. They list the specific labs that require which mods. See MCR Claims Processing Manual Ch 8, Section 50.15, Chapter 16, Sections 40.6.1, 902 & 90.3 ; MCR Benefit Policy Manual Ch 11, Sections 10, 30.2, 30.2.2, 30.5; MCR Claims Processing Manual Ch 16, CMS Manual System Pub 100-20 One Time Notification Change Request6683; MLNMatteras MM4101, MM3890, MM7064Palmetto GBA Jurisdiction 11 Part B under HCPCS Modifier AY, CD, CE, CF