If reporting bilateral procedures and services wasn't confusing enough due to having more than one way to report this on the claim, now there's a new rule for DME suppliers. Medicare requires the right (RT) and left (LT) modifiers to be used with orthosis base codes, additions, and replacement parts. As of March 1, 2019, Medicare began denying claims for bilateral supplies when the claim included both the RT and LT modifiers on the same claim line, but only for certain supply codes. The preferred method is to bill each item on a separate claim line where one line includes the supply code with modifier RT and the second line includes the supply code with modifier LT as shown in the following example:
Standard Documentation Requirements Policy Article (A55426)
Note that this change only applies to the reporting of bilateral modifiers RT and LT. The use of other required modifiers (i.e., KX, GA, GZ) still applies.
For information about reporting bilateral procedures/services, CLICK HERE.
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:
More than 43% of Medicare beneficiaries are not enrolled in Medicare Advantage plans, which were established to control costs and improve quality. However, as noted in the March MedPac Report Executive Summary of 2021, these plans average an estimated 104% of Medicare Fee-For-Service (FFS) spending. How does CMS plan to manage Medicare Advantage plans now?
Providers need to begin preparations for how to handle a return to pre-COVID-19 public health emergency (PHE) policies. As the saying goes, "you can't put the rabbit back in the hat." Some COVID-19 PHE policies are so well liked it will be very difficult for the government to return to pre-COVID-19 policies. For now, we have at least the promise of a 60-day notice to all governors precipitating the end of the PHE.
Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any other utilization tool other than the two-midnight rule to your Medicare admissions? Over the last few months, it has...
Question: If CCM hours/work is to be billed monthly, and CCM tasks are done daily throughout the month, should it be saved until the end of the month to bill, and should each date be billed as DOS in one claim?
Answer: According to CMS, “The service period for CPT 99490 ...
When reporting CCM or TCM codes, you will only get reimbursed for what is allowed. The E/M office visits can be coded in addition but are not interchangeable with CCM codes. You can bill an E/M visit during the time a patient is under Care Management, however, you can’t count time ...
Question: Is there a financial penalty for billing over the allowed amount?
Answer: Yes, if you are submitting claims to a contracted provider, you cannot bill over the contracted amount of your fee schedule. This is called balanced billing. There is also the no-surprise rule that protects insured and non-insured or ...