10/14/2021

Wellcare Denial for 28750-Requiring Modifier

Attached is another claims asking for a modifier for a 28750 what modifier would they want

A modifier is required for CPT 28750 to be paid- Wellcare did deny the claim correctly. When billing for this arthrodesis procedure, the service should be billed with one of the following modifiers depending on the site the surgery was performed:

• -TA for arthrodesis performed on the first MPJ of the left foot
• -T5 or arthrodesis performed on the first MPJ of the right foot

Modifiers should be reported on every claim submitted to code the surgical service to the greatest level of specificity to ensure prompt payment.