Ankle-Foot/Knee-Ankle-Foot Orthoses Modifier Denials

Reason Code 4, Remark Code N519 has remained a top denial for the ankle-foot/knee-ankle-foot orthosis policy. This denial indicates incorrect modifier usage. Errors that contribute to this denial include the KX modifier being incorrectly appended to claims. The KX modifier should only be appended to claims when all the coverage criteria from the policy have been met; otherwise, the GA or GZ modifier should be appended.

Additionally, errors were seen because claims were missing RT and/or LT modifiers. The RT or LT modifier must be appended to the claim line, per the policy requirements. If a brace is needed bilaterally on the same date of service, the RT and LT modifiers must be appended on two separate claim lines and billed as one unit of service each on each claim line.

For modifier information, refer to the Noridian Medicare Modifier page and Modifier Lookup Tool.

Last Updated Dec 11 , 2024