States Applicable to Alert: California, Hawaii, Nevada, Guam, Northern Mariana Islands and American Samoa
Background Information: Because the CPT procedure code G0104 was not set up in the system to be performed in an Ambulatory Surgical Center (ASC), the services were denied in error.
Applies To Procedure Code(s): G0104
Modifier(s): Use modifier SG prior to January 1, 2008. No modifier is required for dates of service since January 1, 2008.
Remark /Reason Codes:
8 – The procedure code is inconsistent with the provider type or specialty, taxonomy.
N95 – This service is not covered when performed by this provider.
MAC Action: After the system is updated, a mass adjustment will be performed on claims denied incorrectly.
Provider Action: No action required.
Date Reported: March 2, 2009
Date Resolved: Open