Question: I’ve heard that Medicare has a new way to override genderspecific edits, when appropriate, based on patient circumstances. Are we supposed to use a specific modifier?
Arizona Subscriber
Answer: You’ll use new condition code 45 (Ambiguous gender category) with claims that may be denied “due to sex/diagnosis and sex/procedure edits,” according to MLN Matters article MM6638.
You’ll use this code when “the service performed is gender specific (i.e., services that are considered female or male only),” the [...]
