Author Topic: Optumhealth/Unitedhealthcare rejects 98943 as it needs a modifier?!  (Read 1694 times)

2012billingrep

  • Newbie
  • *
  • Posts: 23
We are having numerous claims rejected for 98943 because it doesn't have the 'appropriate modifier'. We have called Optumhealth to ask what modifier is required. Not getting any answers at all. Does anyone know what modifier to use??

We bill chiropractic and have never used a modifier for 98943. It is done in conjunction with 98941 (spinal manipulation), 97014 (electrical stimulation), 97140-59 (manual therapy)


DMK

  • Hero Member
  • *****
  • Posts: 680
Re: Optumhealth/Unitedhealthcare rejects 98943 as it needs a modifier?!
« Reply #1 on: March 27, 2014, 09:52:55 AM »
You may want to make sure that your authorization through Optum included an extremity diagnosis.  If it's not in the auth, they won't pay.

2012billingrep

  • Newbie
  • *
  • Posts: 23
Re: Optumhealth/Unitedhealthcare rejects 98943 as it needs a modifier?!
« Reply #2 on: March 27, 2014, 09:59:17 AM »
Thanks. We did check that and we were authorized for that specific code (ie authorized for 98940 through 98943). That's why we're stumped on what else we are missing.

2012billingrep

  • Newbie
  • *
  • Posts: 23
Re: Optumhealth/Unitedhealthcare rejects 98943 as it needs a modifier?!
« Reply #3 on: March 27, 2014, 10:53:24 AM »
I just found the reason on Optumhealth's policy. It says "The extraspinal CMT code, 98943 must be accompanied by modifier -51, when billed on the same date of service as a spinal"


DMK

  • Hero Member
  • *****
  • Posts: 680
Re: Optumhealth/Unitedhealthcare rejects 98943 as it needs a modifier?!
« Reply #4 on: March 27, 2014, 12:52:51 PM »
Makes sense!  Thank you for posting the answer to the problem.  It's a great help to others having the same problems!