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Surgical Dressings Billed with GW Modifier Pre-Pay Review Quarterly Status Report

Below is the analysis of claim denials for GW modifier surgical dressings HCPCS codes A4452, A6213, A6219, A6222 and A6446 reviewed between October 1 and December 31, 2023. The error rate for this quarter is 100%. The top 3 reasons for claim denials are as follows:

Rank Reason Percent
1. Invalid use of GW modifier. 81.82%
2. Payment for supplies billed above normal policy usage is being denied due to lack of documentation to support that they are reasonable and necessary. 9.09%
3. The claim submitted is a duplicate to another claim billed. 9.09%

*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:

Updated: February 2, 2024

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