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As a reminder, providers and office staff should adhere to industry standards when submitting medical documentation for claims reconsiderations. CCA would like to refer providers and staff to the following guidelines.

Unlisted Procedure Codes

Increased Procedural Services (Modifier 22)

Missing Documentation

When submitting claims reconsiderations, please submit medical documentation to support the service(s) appealed. Insufficient, illegible, and missing medical documentation will result in denials of appeal requests. This includes missing invoices for durable medical equipment (DME) and specialty drugs.

Modifier 57

When submitting claims reconsiderations for Modifier 57, please append where the initial decision to perform the surgical procedure is made. This should be done the day of or the day before an evaluation and management service. 

For additional policy guidance, including clinical and medical necessity guidelines, please visit: