Medicare Changes Bilateral Reporting Rules for Certain Supplies

December 30th, 2019 - Wyn Staheli, Director of Research
Categories:   DME|Supplies|Equipment   HCPCS Coding   Modifiers  
0 Votes - Sign in to vote or comment.

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:

L4392-RT

L4392-LT

This change affects all DME jurisdictions, but as mentioned above, ONLY for certain supplies as found in the following articles:

  • Ankle-Foot/Knee-Ankle-Foot Orthoses (A52457)
  • External Breast Prostheses (A52478)
  • Eye Prostheses (A52462)
  • Facial Prostheses (A52463)
  • Knee Orthoses (A52465)
  • Lower Limb Prostheses (A52496)
  • Orthopedic Footwear (A52481)
  • Refractive Lenses (A52499)
  • Surgical Dressings (A54563)
  • Therapeutic Shoes for Persons with Diabetes (A52501)
  • Wheelchair Options/Accessories Policy Article (A52504)
  • 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.


Latest articles:  (any category)

Coding with PCS When There is No Code
August 5th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn?  To the guidelines, of course! There are ICD-10-PCS guidelines just as ...
To Our Codapedia Friends!
July 30th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Codapedia friends, come and join us at Find-A-Code - a core product of innoviHealth! The information found on Codapedia comes from our sister company, Find-A-Code. If you do not already have a subscription with the greatest online coding encyclopedia, call us and get signed up today. We are offering a ...
OIG Report Highlights Need to Understand Guidelines
July 28th, 2020 - Wyn Staheli, Director of Research
A new OIG report once again highlights the necessity for organizations to fully understand requirements for reporting services and having proper documentation. The types of problems addressed in this report are ongoing issues for multiple types of services and specialties and for many different payers.
Office of Inspector General Says Medicare Advantage Organizations are Denying Services Inappropriately
July 21st, 2020 - Aimee Wilcox
We attended the recent virtual RISE National Conference and had the opportunity to listen to presenters share their knowledge about risk adjustment and HCC reporting and data validation. Among the presenters were representatives from the Office of Inspector General (OIG), who presented findings from encounter data from 2012-2016. They began ...
Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab
July 15th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD).  Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.   When reporting 93668 for peripheral arterial disease rehabilitation the following ...
New Name Same Great Product! "HCC Plus"
July 14th, 2020 - Find-A-Code
Hello HCC Customers! We have made a change in name only to our HCC subscription. The new subscription is now called “HCC Plus”. Keep in mind there have been no changes to the product. Using your subscription along with the risk adjustment calculator will ensure you stay current with...
Are NCCI Edits Just for Medicare?
July 14th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2020 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association