Forum - Questions & Answers

Feb 16th, 2014 - kimkalal

Are add-on codes subject to bilateral (modifier 50) pricing (150%

Feb 16th, 2014 -

re: Are add-on codes subject to bilateral (modifier 50) pricing (150%

Example:
64483-RT-100%
64483-LT-50%
64484-RT-add on code - 100%
64484-LT- add on code- ???? 50% or 100%?
CMS gives 64484 a MULT SURG value of 0 (=No payment adjustment rules for multiple procedures apply. If procedure is reported on the same day as another procedure, base the payment on the lower of (a) the actual charge, or (b) the fee schedule amount for the procedure.)
And a BILATERAL indicator of 1 (=150% payment adjustment for bilateral procedures applies. If the code is billed with the bilateral modifier or is reported twice on the same day by any other means (e.g., with RT and LT modifiers, or with a 2 in the units field), base the payment for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides or (b) 150% of the fee schedule amount for a single code. If the code is reported as a bilateral procedure and is reported with other procedure codes on the same day, apply the bilateral adjustment before applying any multiple procedure rules.
My thought was ALL add on codes should be reimbursed at 100% and re never cut back. CMS seems to be saying to cut the second add on code to 50%.

Is this correct???? Help!

Feb 16th, 2014 - nmaguire   2,606 

re: Are add-on codes subject to bilateral (modifier 50) pricing (150%

Mod-50 can only be used for organs/body parts present on both sides of the axisl(middle) part of the body, i.e.. eyes, extremities, lungs, kidneys...



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