10/23/2023

Excellus Denial for CPT 97597-No Modifier Present

Excellus just denied a claim with CPT code 97597 stating there was no modifier present. they paid the same claim that was billed three weeks prior without modifier. Are modifiers now required when billing 97597? Any info will help in clinical edit dispute.

This denial from Excellus is incorrect, a modifier is not needed for a wound debridement. A modifier is only required if the rendering provider is a physical therapist, and the -GP modifier is added to indicate that the procedure is related to an outpatient care plan. Podiatrists do not need to use this modifier if they are performing wound care. Progress notes should be submitted with the clinical edit review form to show that these are not related to therapy services.