CARC · CO group

CO-4

Procedure code inconsistent with the modifier used, or a required modifier is missing

Contractual obligation; provider write-off unless appealed

What it means

The payer accepted the procedure code but rejected the modifier combination attached to it.

Likely cause

Telehealth modifiers (95, GT) or place-of-service pairings applied inconsistently, or an add-on psychotherapy code billed without the modifier the payer expects.

How to fix it

Confirm the payer's current telehealth and add-on modifier policy, correct the modifier, and resubmit as a corrected claim rather than a new claim.

Revenue impact

Fully recoverable if corrected inside the timely-filing window.

• modifier
• telehealth
• coding