Forum - Questions & Answers

Mar 28th, 2018 - lisacaroltex

BCBS improper use of modifier denial

We have not been paid on G0442, G0444, G0446 nor G0447 by BCBS since their new audit went into effect in November 2017. We have tried every combination of modifier use to get them to process these codes and even gone to appeal. I have not been able to find or obtain any information from BCBS as to what combination of modifiers or codes they are looking for. The new audit is being driven by Verscend software.

May 29th, 2018 - ChrisW   256  1 

re: BCBS improper use of modifier denial

There are other considerations such as the setting and what else is being billed. G0443 is bundled into E/M codes, however, a modifier is allowed, you would append modifier 25 to the E/M code, not the HCPCS code. If reporting Preventive Services to report quality metrics report with Modifier 33. Modifier 33 is used to indicate Preventive Services to report quality metrics and is informational only; it has no impact on reimbursement. Modifier 33 should be reported only to private payers, Medicare and Medicaid do not recognize this modifier. If you have more information that needs to be considered please let us know.

May 29th, 2018 - ChrisW   256  1 

re: BCBS improper use of modifier denial

There is a lot to consider here. Find-A-Code has information on Documentation and rules and guidelines. I would suggest to start with your Medicare carrier and look up the LCD’s for your location. Something else to consider, when billing orthotics, verify with your payer, but CMS requires a supplier to bill with the Place (POS) of “Home” even when they are delivered to a Nursing facility.



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