Forum - Questions & Answers

Oct 19th, 2016 - benohelvin

64636 - Pain Management Billing Issue

HI All,
CPT® 64636 are getting denied as inclusive
This CPT® has been billed twice on all the claims with 50 modifier on both the CPT's and 59 on the second CPT®.

(I.e) 64636 - 50, 69636-50-59

The first CPT® billed has been paid and other is denied.

Per medicaid & Medicare rep the if CPT® is billed with 50 modifier then that itself means that the procedure is bilateral and there is no need to bill the CPT® twice and distinct it with modifier 59.
Hence no further payment cannot be made on the claim.

Is there any possibilities to get this paid or This billing itself is wrong ? Please provide us answer.

This service was performed in Same Spinal card but different region?

Oct 19th, 2016 - LBAROGIANIS 250 

re: 64636 - Pain Management Billing Issue

This is not my specialty but it appears that 64635 would be the primary code and 64636 is the additional code. How many levels does the provider denervates? If both facet joints are at the same level then you can use modifier 50.

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