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Modifier 76

S

sweetladyde

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Suffield, CT
Has anyone used modifier 76 for a bilateral cerumen impaction? My new employer is insisting that is the only way Medicaid will pay that service. But obviously the description for modifier 76 does not apply😔
 
the codes used for cerumen impaction 69209 unilateral and 69210 bilateral, these codes wouldn't need a modifier as the laterality is included in the code description. You could also reach out to your state's Medicaid and see how they want it billed.
 
Both 69209 and 69210 are unilateral codes. Per CMS, 69209 is reimbursed at 150% with modifier 50, but 69210 will only be reimbursed at 100% even when performed bilaterally, as CMS feels the physiologic processes that create cerumen impaction likely will affect both ears,” according to the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS). So, CMS regards the service as inherently bilateral and modifier 50 should not be appended. Modifier 76 signifies a repeat service after an initial service on the same day. So, unless you are reporting that the service was repeated twice on the same day, you should not use 76.
 
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