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Code/Modifier Combination Invalid & Modifier Invalid/Missing

Code/Modifier Combination Invalid and Modifier Invalid/Missing

Remark Code/ Message Number: 
• 4: The procedure code is inconsistent with the modifier used or a required modifier is missing
• MA130: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.

Resolution 
• Review the CPT/HCPCS code narratives to determine if a modifier is needed
• Verify that the submitted modifier is appropriate to be submitted with the procedure code
• Access complete instructions for correctly submitting all CPT and HCPCS modifiers on the ‘Palmetto GBA Modifier Lookup’ Web page. Select ‘Self Service Tools’ on the Palmetto GBA Web page.

Anesthesia Services: Bundling Denials

Denial Reason, Reason/Remark Code(s)
• B15 – Bundling: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
• CPT code: 99100

Resolution/Resources

• This code is listed as ‘Status B’ in the Medicare Physician Fee Schedule Database (MPFSDB), which means that payment for this service is always included in payment for other services performed on the same date that are reimbursed under the Medicare Physician Fee Schedule

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