Surgery modifiers

I am a biller in an ENT practice. I recently submitted a claim for a surgical procedure to remove a lesion from a patient's nasal passages. The claim was denied by our Highmark Medicare Advantage Plan as being cosmetic. When I called them today, I was told there was a specific modifier to use on the procedure to note that it was not a cosmetic procedure. I cannot find such a modifier anywhere and I am wondering if anyone knows where I could find it. I've never run into it before. My CPT® code is 11442. Thank you.

re: Surgery modifiers

I personally have never heard of such a modifier but, I did check their medical policies at https://www.highmarkblueshield.com/pdf_file/HighmarkBlueShield-Section15.pdf and still did not find anything. I also quickly scanned level II modifiers and found nothing....sorry. You may have to call them back to try to get more insight or perhaps someone else can better answer. Best wishes!

re: Surgery modifiers

Your diagnosis establishes medical necessity. I am not aware of such a modifier. Also code symptoms if documented.