How do I correct a CO-4 denial (the procedure code is inconsistent with the modifier used, or a required modifier is missing)? How do I determine what the cause is?
There are several possible causes for a CO-4 denial. Use the information below to assist in determining the issue and submit a corrected claim. • Review the required modifiers for the payment category of the item(s) you are billing. For more information on payment categories and their related modifiers, please refer to the DME MAC Jurisdiction C Supplier Manual Chapter 5. • If billing for capped rental items with initial dates prior to 01/01/06, or enteral/parenteral pumps, check to see if the purchase option modifier is required. Payment cannot be made past the 11 th rental month without indicating whether the beneficiary has decided to continue to rent or purchase the equipment. For more information regarding the rental/purchase option, please refer to the DME MAC Jurisdiction C Supplier Manual, Chapter 5. • If billing with an EY modifier, check to see if there are any other claim lines that do not contain the EY modifier. If a claim line contains an EY modifier, then all other line
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