Receiving Denials for HCPCS code is Inconsistent with Modifier Used or Required Modifier is Missing

Rework for correcting claims and rebilling when required modifiers are missing or procedure code does not require modifier that was appended to claim line. This is one of the most frequent denials that suppliers receive. We have the solution, utilize the Noridian Modifier Lookup Tool to ensure all potential modifiers are included on the claim along with referring to the appropriate Local Coverage Determination (LCD) and LCD Policy Article. To resolve denial:

  • Correct claim line with appropriate required modifier and resubmit claim

            Last Updated Tue, 09 Aug 2022 17:30:54 +0000