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  4. Frequently Asked Questions
  5. Modifiers
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© 2021 Palmetto GBA, LLC

We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.

Published Date:12/01/2020

Printed Date: 9/22/2015

URL: http://palmgba.com/marlowe/redesign6/article.html

My claim was returned with the message ‘The procedure code is inconsistent with the modifier used or a required modifier is missing.’ I submitted two modifiers, and they should both be valid for the procedure code. Why was my claim rejected?

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Answer
The Multi-Carrier System (MCS) requires the functional (pricing) modifier to be placed in the first modifier field in order to process the claim correctly. To avoid processing delays, informational (statistical) modifiers should follow the functional modifier. 

The following is a list of functional modifiers recognized by MCS: 

HCPCS Modifiers
CPT Modifiers
AA
22
AD
26
AS
50
KD
51*
QK
52
QX
53
QY
54
QZ
55
TC
62
 
66
 
73
 
74
 
78
 
80
 
81
 
82

*We strongly recommend that you do not submit this modifier to Palmetto GBA. Palmetto GBA will apply this modifier to indicate when special pricing rules have been used to calculate the reimbursement.

Please refer to the Palmetto GBA Modifier Lookup under Tools on the home page for more information about each modifier.

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Last Updated: 12/01/2020

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