Urological Supplies Billed with GW Modifier Pre-Pay Review Quarterly Status Report
Below is the analysis of claim denials for GW modifier urological supplies HCPCS codes A4316, A4351, A4352, A4353 and A4355 reviewed between October 1 and December 31, 2023. The error rate for this quarter is 100%. The reason for claim denials are:
Rank | Reason | Percent |
---|---|---|
1. | The medical records from the treating practitioner do not document an impairment of urination. | 100.00% |
*The total percentage will be greater than 100% because some claims were denied for multiple reasons.
**The error rate included is an overall average for the supplier specific reviews as a part of the Targeted Probe and Educate program. This is not meant to represent an overall error rate for the HCPCS code or policy under medical record review.
Resources:
- GW Modifier Usage for Hospice Patients
- Hospice and GW Modifier Prepayment Reviews
- Medicare Minute℠ Hospice and GW Modifier
- Urological Supplies: Intermittent Catheters Documentation Checklist
- Urological Supplies – LCD (L33803)
- Urological Supplies – Policy Article (A52521)
Updated: February 2, 2024