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Old 07-09-2008, 01:42 PM
nanp nanp is offline
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Default # of units per CPT code

We are having problems getting some of our procedures paid when we bill them with more than one unit, especially with Medicare patients. Are you aware of and know where I could find a publication that states how many units are allowed per CPT code for Medicare.

Sincerely,
Nancy Potier, CPC, CPC-CTS
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Old 07-09-2008, 01:43 PM
Lisa Bledsoe Lisa Bledsoe is offline
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What CPT codes are you using?
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Old 07-09-2008, 01:47 PM
nanp nanp is offline
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The codes we are having the most problems with currently are 35470 - 35495.
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Old 07-09-2008, 01:54 PM
Sunny0967 Sunny0967 is offline
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I had read in the January issue of HCPRO ASC Insider that MCR was going was requesting we use the -50 modifier or units (2) for bilateral procedures. I started billing that way and ran into nothing but problems. What is it you are having issues with. I was also told by MCR if biling 15823 or 67904 not to use either, but to bill on separate lines as it used to be.

I have discontinued billing by units at all. I do sometimes still use modifier 50 though.

Hope this info helps.
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Old 07-09-2008, 02:12 PM
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For us, Medicare wants bilateral procedures on ONE line with the .50 modifier and units = 1 / so 35470.50 (units 1)If multiple (not bilateral), use modifier .51on the multiple ones.

35495 you can't use a .50 with this code.
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Old 07-09-2008, 05:16 PM
happycoder07 happycoder07 is offline
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Default Units

Hello,

The insurance company I work for requires that when the 50 modifier is billed on CPT codes, should be on 1 line for appropriate payment (no multiple units), rarely will problems come up when submitted this way.

Many providers will bill with the RT/LT modifiers on 2 separate lines if applicable.

Pedenia Y. Evans, CPC

Last edited by happycoder07; 07-09-2008 at 05:17 PM. Reason: misspelled word
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Old 07-10-2008, 07:49 AM
Lisa Bledsoe Lisa Bledsoe is offline
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Quote:
Originally Posted by nanp View Post
We are having problems getting some of our procedures paid when we bill them with more than one unit, especially with Medicare patients. Are you aware of and know where I could find a publication that states how many units are allowed per CPT code for Medicare.

Sincerely,
Nancy Potier, CPC, CPC-CTS
Have you checked your LCD's for your carrier? I think these codes would need to either be billed out on separate line items with -59 or on one line item with -50 and 1 unit (like Donna said) if bilateral. Who is your carrier (FI/MAC)?
Lisa
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Old 07-22-2008, 08:54 AM
gentrta1 gentrta1 is offline
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Question Multiple units billed to Medicare


Back in March I contacted Medicare via email searching for listing of how many units can be billed with cpt codes. The focus was on labs and path and all other cpts. I did receive a phone call from Medicare and the direction it took was to MUE's which explains that all the FI's have a list but it is not published and not available for provider/biller consumption!
So, as we go along we have compiled a listing of cpt/unit edits. If anyone else has had better luck in obtaining more information that would be great!

Tamara M. Gentry, RHIT, CPAR, CPC

Newbe to the CPC world! Just passed my test a couple of weeks ago! I have ALOT of respect for coders!
 
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