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HUMANA DENYING PODIATRY DME

Jean Posted Sun 29th of August, 2010 10:43:24 AM

HUMANA IS DENYING ALL OF MY DME CODES FOR
INCORRECT MODIFIER

EXAMPLE L3485 LT
L1930 RT

PLEASE HELP - HAVE HAD NO TROUBLE WITH ANY
OTHER INSURANCE COMPANIES

SuperCoder Answered Mon 30th of August, 2010 04:15:09 AM

I think you might add some additional modifiers, suppliers must add a KX modifier to the AFO/KAFO base and addition codes only if all of the coverage criteria in the “Indications and Limitations of Coverage and or Medical Necessity” have been met and evidence of such is retained in the supplier’s files and available to the DME upon request.

If all of the criteria in the Indications and Limitations of Coverage and/or Medical Necessity section have not been met, the GA or GZ modifier must be added to the code. When there is an expectation of a medical necessity denial, suppliers must enter the GA modifier on the claim line if they have obtained a properly executed Advance Beneficiary Notice (ABN) or the GZ modifier if they have not obtained a valid ABN.
When billing for a shoe that is an integral part of a leg brace or for related modifications, inserts, heel/sole replacements or shoe transfer, a KX modifier must be added to the code. If the shoe or related item is not an integral part of a leg brace, the KX modifier must not be used.

Claims lines billed with codes without a KX, GA or GZ modifier will be rejected as missing information.

Jean Posted Mon 30th of August, 2010 10:25:46 AM

Thank you so much

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