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Last Modified: 5/3/2020 Location: FL, PR, USVI Business: Part A, Part B

Restricted modifiers and procedure codes FAQ

Q. What are the restricted modifiers and procedure codes that cannot be corrected through the reopening process using SPOT?
A. Modifier GY (item or service statutorily excluded or does not meet the definition of any Medicare benefit) may not be corrected through the Secure Provider Online Tool (SPOT). In fact, due to their nature, there are several modifiers and procedure codes in which claims may not be corrected through SPOT.
Here is a list of modifiers and procedure codes that cannot be corrected using SPOT:
Modifiers that cannot be corrected using SPOT include:
21, 22, 24, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, SG, WU
CPT/HCPCS that may not be corrected using SPOT include:
J0200, J0390, J0395, J0520, J0735, J1094, J1700, J1710, J1885, J1960, J1990, J2323, J2440, J2670, J2760, J3490, J3590, J7130, J7184, J7199, J7310, J7326, J7628, J7629, J7648, J7658, J7659, J7683, J7684, J8499, J9165, J9201, J9217, J9219, J9270, J9357, J9999, Q0144, Q2027, Q2034, Q2035, Q2036 Q2037, Q2038, Q2039, Q2045, Q2046, 90654, 90655, 90656, 90657, 90658, 90659, 90660, 90667, 90668, 90715, 90724, 90779, 96549
If your claim includes any of the modifiers or procedure codes listed above, you may submit a request for redetermination using SPOT’s Secure Documentation.
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