We have had claims for replacement ICDs denied because they didn’t have a modifier. Can we request an adjustment for these?
Yes, you may request an adjustment for claims for any date of service for which the replacement ICD was otherwise covered.
Note also that, in February 2018, the Centers for Medicare & Medicaid Services (CMS) decided that ICDs no longer need modifier Q0 as the data-collection requirement is no longer needed. The updated national coverage determination with the requirements can be found at https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=288&TimeFrame=7&DocType=All&bc=AAAAIAAAQAAA&. See also https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3204CP.pdf.