Reason Code 4 | Remark Code N519

Code Description
Reason Code: 4 The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Remark Code: N519 Invalid combination of HCPCS modifiers.

 

Common Reasons for Denial

  • HCPCS code is inconsistent with modifier used or required modifier is missing

Next Step

  • Resubmit claim line with correct modifier for processing. It is not necessary to go through Reopening process

How to Avoid Future Denials

  • Use appropriate modifiers per appropriate Local Coverage Determination (LCD) and LCD Policy Article

 

Last Updated Apr 18, 2018