Forum - Questions & Answers

Aug 3rd, 2016 - TIMKY2 1 

Billing for Medically Necessary Contact Lenses

I am ready to pull out my hair out!

I got an authorization to bill V2521, qty of 8 at a unit rate of $19.48. We dispense a year's supply so we are billing by the box and there are 6 contact lenses in a box. I billed V2521 on two lines with a qty of 4 each with a RT modifier and the second line with a LT modifier. I got a denial that it exceeded the MUE threshold.

When I looked up the NCCI edits I got and MUE value of 2, Adjudication Indicator: 1 line edit and MUE Rationale: Anatomic Consideration.

My interpretation of this is I can only bill it as
V2521 w/ modifier RT, qty 1 and
V2521 w/ modifier LT, qty 1

If I am right, does anyone know of a modifier that I can use to bill (and get paid) for the other 6 boxes of contact lenses if they are dispensed on the same day or is there a better way to bill it.

I am probably overthinking this and confusing myself so any help would be appreciated.


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