Wiki UHC Medicare Bilateral billing

[gurick@cox.net]

Hi-
Orthopedic practice has a question- The UHC billing guideline never mentions using "2" units for bilateral xray codes, but....

When billing UHC Medicare for bilateral procedures that fall under the "3" indicator ( CMS NPFS)
are you using modifier -50 with 1 unit and price increase or RT,LT with 2 units?

Thank you for your response.

 

[TThivierge]

Gurick
I bill modifier 50 if bilater. limbs or organs, with unit of 1 but depends on Xray CPT code definition of unilateral or multiple views on one area. Use 1 unit and modifier 50 and correct DX code linked. Some dx codes are bilateral and some dx codes are right then left side of body. Examples look at dx block M16-M18 has bilateral, but other dx related to muscles have separate right and left dx codes.Check with payer to be sure it might vary
I hope this helps
Lady T

 

[gurick@cox.net]

Gurick
I bill modifier 50 if bilater. limbs or organs, with unit of 1 but depends on Xray CPT code definition of unilateral or multiple views on one area. Use 1 unit and modifier 50 and correct DX code linked. Some dx codes are bilateral and some dx codes are right then left side of body. Examples look at dx block M16-M18 has bilateral, but other dx related to muscles have separate right and left dx codes.Check with payer to be sure it might vary
I hope this helps
Lady T

Thank you for the reply.....we too code as you mention. Has UHC requested (numerus) refunds on claims billed as above?