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Last Modified: 9/9/2022 Location: FL, PR, USVI Business: Part A, Part B

Restricted codes for claim reopenings FAQ

Q. Are there restricted modifiers, procedure codes, or denial codes that cannot be corrected through the reopening process using SPOT?
A. Due to their nature, there are several modifiers and procedure codes in which claims may not be corrected through SPOT. In addition, if a claim includes the denial codes listed below, it cannot be corrected in SPOT.
Modifiers that cannot be corrected using SPOT:
21, 22, 23, 24, 51, 52, 53, 55, 56, 62, 66, 73, 74, 99, CC, GA, GM, GX, GY, GZ, PA, PB, PC, SG
CPT/HCPCS that cannot be corrected using SPOT:
90654, 90655, 90656, 90657, 90658, 90659, 90660, 90667, 90668, 90715, 90724, 90779, 96549, C9041, C9132, C9133, C9134, C9135, C9137, C9138, C9139, C9140, C9141, C9267, J0200, J0390, J0395, J0520, J0735, J1094, J1700, J1710, J1885, J1960, J1990, J2323, J2440, J2670, J2760, J3490, J3590, J7130, J7170, J7175, J7177, J7179, J7180, J7182, J7183, J7185, J7186, J7187, J7188, J7189, J7190, J7191, J7192, J7193, J7194, J7195, J7196, J7197, J7198, J7199, J7200, J7202, J7203, J7207, J7209, J7211, J7310, J7326, J7628, J7629, J7648, J7658, J7659, J7683, J7684, J8499, J9165, J9201, J9217, J9219, J9270, J9357, J9999, Q0144, Q0187, Q2022, Q2023, Q2027, Q2034, Q2035, Q2036, Q2037, Q2038, Q2039, Q2045, Q2046, Q9995
If a claim includes the following denial codes, it cannot be corrected using SPOT:
043, 051, 074, 083, 117, 118, 127, 135, 181, 224, 225, 226, 227, 235, 299, 300, 309, 310, 324, 346, 382, 387, 394, 395, 406, 413, 458, 483, 504, 512, 513, 531, 538, 552, 573, 581, 590, 596, 602, 627, 633, 634, 636, 637, 638, 650, 791, 792, 883, 889, 908, A18, A59, A60, A61, A62, A63, A64, A67, A75, A76, A82, AE2, AE7, AE8, AE9, C09, C10, C38, C39, C78, D01, D02, D03, D04, D05, D06, D07, D051, D083, D117, D118, D181, D224, D225, D382, D458, D504, D538, D627, D908, DA18, DA75, DA76, DA82, DC10, DC38, DC39, DC78, E14, E15, E19, E20, E21, E72, E85, E86, E88, E90, E96, E97, E98, H06, H82, H97, J61, J85, J86, J87, J89, K74, K78, K81, K88, K90, K92, K93, K94, K96, K97, K98
If your claim includes any of the modifiers, procedure codes, or denial codes listed above, you may submit a request for redetermination using SPOT’s Secure Documentation.
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