09/20/2023

Emblem Health Denial for CPT L4387

CPT: 99203-25-paid 73630-LT-paid 29580-LT-paid L4387-LT Insurance is Emblem Health L4387 denied stating "procedure code inconsistent with modifier usage" and "this should be billed with the appropriate code for these services". Other than LT, what would be the appropriate code or modifier for L4387?

The DME purchase was denied by Emblem Health because of the missing -KX modifier. The payer follows DMERC guidelines for covered items such as AFOs and night splints. Submitting a replacement claim to Emblem with the modifier added should adjust the charge to pay.