Quick Explanation
This denial indicates that the payer has rejected the claim because patient care was transferred to another provider during a global service period. It typically occurs when a surgical procedure and the subsequent postoperative care are split between different clinicians, but the claims were not billed using the appropriate split-care modifiers.
Common Causes for CO-90
Denials with code CO-90 typically happen for the following specific reasons:
- Billing the global surgical CPT code without modifiers when the billing provider only performed either the surgical portion or the postoperative management.
- Failure to append modifier 54 (Surgical care only) or modifier 55 (Postoperative management only) to the claim to signal split-care billing.
- Mismatched transfer-of-care dates or conflicting billing codes submitted by the operating surgeon and the postoperative physician.
- Submitting postoperative evaluation and management claims during a global period without a documented and mutually signed transfer of care agreement.
How to Prevent CO-90 Denials
To avoid receiving this denial in the future, implement these specific checks:
- Secure a written, signed transfer of care agreement between the operating surgeon and the receiving physician documenting the exact date responsibility is transferred.
- Coordinate with the other provider's billing office prior to submission to ensure that CPT codes, modifiers, and transfer dates match perfectly.
- Append modifier 54 to the surgical code if performing only the surgery, and modifier 55 to the surgical code if only performing the postoperative management.
- Report the exact date of transfer in Box 19 of the CMS-1500 claim form or the equivalent electronic loop to facilitate automatic processing.
Appeal Letter Template for CO-90
If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.
[Your Practice Header]
[Date]
[Payer Name]
[Appeals Department Address]
RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: CO-90 - Patient care was transferred to another provider
Dear Appeals Department,
I am writing to appeal the denial of the above-referenced claim, which was denied with code CO-90: "Patient care was transferred to another provider".
We are appealing the denial of this claim under denial code CO-90 regarding the transfer of patient care. According to the CMS Medicare Claims Processing Manual, Chapter 12, Section 40.2, split-care billing is appropriate and reimbursable when there is a documented transfer of postoperative care. The surgical procedure was performed by [Insert Surgeon/Facility Name] on [Insert Surgery Date], and care was formally transferred to our clinic on [Insert Transfer Date] for postoperative management. We have correctly appended Modifier 55 (Postoperative management only) to CPT code [Insert CPT Code] and entered the transfer date in the appropriate claim field. The enclosed transfer agreement and medical records substantiate this arrangement. We respectfully request that this denial be overturned and payment be issued accordingly.
Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].
We respectfully request that you reprocess this claim for payment.
Sincerely,
[Your Name]
[Title]
[Practice Name]
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