You should refer to the inside front cover of your current CPT code book and resubmit your denied charge with a modifier to document an unrelated evaluation and management service by the same physician during a postoperative period.

Your claim appears to have been denied appropriately. Since the visit/consultation is related to the previous procedure/surgery, the allowance is included with the payment for the surgery. The patient should not be billed for the denied charge.

Please call our Customer Service Department toll free at 1-877-288-7600 to get information about your claim denial. Be prepared to give the doctor’s Railroad Medicare PTAN from the remittance notice, as well as the patient’s identifying information.

You should refer to the inside front cover of your current CPT code book and resubmit your denied charge with a modifier to document a staged or related procedure or service by the same physician during the postoperative period.

Your claim appears to have been denied appropriately. Since the denied charge is related to the previous surgery but not a return to the operating room or a staged procedure, the allowance is included with the payment for the previous surgery. The patient should not be billed for the denied charge.