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)

How to Combat COVID-Related Risk Adjustment Losses with the Medicare Annual Wellness Exam
April 12th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Identifying new ways to encourage Medicare beneficiaries to schedule and attend their Annual Wellness Exam (AWE) can be difficult, but the Open Enrollment period is a prime time for every payer to identify new beneficiaries and provide a reminder to both new and existing patients that this preventive service does ...
Failure to Follow Payer’s Clinical Staff Rules Costs Provider $273K
April 12th, 2021 - Wyn Staheli, Director of Research
Clinical staff (e.g., LPN, RN, MA) provide essential services which allow providers to leverage their time and improve reimbursement opportunities and run their practices more efficiently. There is, however, an ongoing question of how to appropriately bill for clinical staff time. This is really a complex question which comes down to code descriptions, federal or state licensure, AND payer policies. Failure to understand licensing and payer policies led a Connecticut provider organization down a path that ended in a $273,000 settlement with both federal and state governments.
Properly Reporting Imaging Overreads (Including X-Rays)
April 8th, 2021 - Aimee Wilcox CPMA, CCS-P, CST, MA, MT and Wyn Staheli, Director of Content Research
hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e.g., independent imaging center), that is typically referred to as an overread or a re-read. Properly reporting that work depends on a variety of factors as discussed in this article.
How Social Determinants of Health (SDOH) Data Enhances Risk Adjustment
March 31st, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.
Understanding Skin Biopsy Codes
March 23rd, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
A biopsy is a procedure to obtain only a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other ...
How Reporting E/M Based on Time May Lose Money
March 18th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...
COVID-19 Vaccines
March 10th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
To accommodate the new COVID-19 immunizations the CPT editorial panel has approved 11 Category I codes. Watch for new and revised guidelines and parenthetical notes with these codes. For example; which administration codes should be used with the vaccine codes and the NCD codes applicable to the dose being administered. These ...



Home About Contact Terms Privacy

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

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association