My claim for post-operative services billed with a modifier for "Postoperative Management Only" was rejected. What information was missing?

Answer:
Failure to submit one or more of the following requirements can result in the rejection of services billed with CPT modifier 55.  

CMS-1500 (02/12) Paper Claims

  • Enter the total number of post-op days in either item 24G or in item 19
  • Enter the date(s) the post-op care was assumed and/or relinquished in item 19
  • Enter the date the surgical procedure was performed as the date of service    

Electronic claims - ASC 837 v5010 Loop, Segment, Element

  • Enter the total number of post-operative days in either the:
    • Days or units field, Loop 2400, SV1, 04 (03=UN)
    • Narrative Loop 2300 or 2400, NTE, 02
  • Enter the date(s) the post-op care was assumed and/or relinquished in either:
    • Loop 2300, DTP/90, or 91, 03
    • Narrative Loop 2300 or 2400, NTE, 02
  • Enter the date the surgical procedure was performed as the date of service  

As a reminder, claims that are rejected with remittance message MA130 should be corrected and resubmitted as new claims. Rejected claims do not have appeal rights. Reopening and redeterminatation requests received for rejected claims will be dismissed.  

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