12/07/2023

Medicare Denials for RFC-Remit Code 151

Billing Medicare for at risk footcare. Diabetic 2 with polyneuropathy. Medicare denied 11056 with co-151 frequency but patient was seen 63 days previous and denied 11720 with co-236 procedure or procedure modifier combination is not compatible. Please see how billed below and tell me what we did wrong.

CPT 11056 was denied by Medicare because the service must have been provided by another provider. Customer service can confirm the last date the service was covered for the beneficiary.

CPT 11721 was denied because it is missing a -59 modifier. A corrected claim with the modifier added should adjust the bundling denial provided that is also not frequency.