Claim Denials Related to the TF Modifier and 97150 Code

August 15, 2012

There was an issue causing claims to deny when a provider billed a TF modifier with a 97150 code. Providers received one of the following denials: - CARC Code 204: This service/equipment/ drug not covered under the patient’s current benefit plan. (This will appear as Edit 202 in MyHealthPAS Online.)

  • CARC Code 185: The rendering provider is not eligible to perform the service billed. (This will appear as Edit 150 in My Health PAS Online.)

This issue has now been resolved and you may rebill your claims if they were denied with one of the reason codes listed above. If you billed without the TF modifier because of this issue, you may now adjust your claim and add the modifier, as appropriate.