Question:

We have had claims for replacement ICDs denied because they didn’t have a modifier. Can we request an adjustment for these?

Answer:

Yes, you may request an adjustment for claims for any date of service for which the replacement ICD was otherwise covered.

Note also that, in February 2018, the Centers for Medicare & Medicaid Services (CMS) decided that ICDs no longer need modifier Q0 as the data-collection requirement is no longer needed. The updated national coverage determination with the requirements can be found at https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=288&TimeFrame=7&DocType=All&bc=AAAAIAAAQAAA&. See also https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3204CP.pdf.

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