Modifiers

Procedure: Right L4, L5 selective nerve root block/transforaminal epidural steroid injection.
Claim: 64483, 64484, Q9966, J1010
United Healthcare rejected claim becaused they need modifiers.
Any one help?
CMS guilines not requests modifier for ?
Help . Tks.
Tra, Son

Pulled from an online search, take it with a grain of salt. United has been asking for strange modifiers for all sorts of things lately.
RT or LT: Append RT (right side) or LT (left side) for unilateral injections to designate the precise laterality, which must match your ICD-10 diagnosis code.
Modifier 50: Append modifier 50 to indicate a bilateral procedure (treating both sides at the same single spinal level in the same session), if allowed by your payer.
KX Modifier: Append the KX modifier if the procedure is a diagnostic selective nerve root block (DSNRB) rather than a therapeutic epidural steroid injection, per specific

These CPT require LT, RT or 50. I would refer to this as basic coding knowledge. It is not UHC being "weird or strange". It is basic coding.
https://www.cms.gov/medicare/physician-fee-schedule/search https://www.cms.gov/help/status-indicators

Bilateral Surgery Indicator (CPT Modifier 50)​

1 = 150% payment adjustment for bilateral procedures applies. If you bill a code with the bilateral modifier, Medicare bases payment for these codes, when reported as bilateral procedures, on the lower of:

• The total actual charge for both sides
• 150% of the fee schedule amount for a single code

If you report a code as a bilateral procedure with other procedure codes on the same day, Medicare applies the bilateral adjustment before applying any applicable multiple procedure rules.

"UnitedHealthcare will apply CMS’s payment adjustment methodology to bilateral eligible procedures with a bilateralindicator of "1" regardless of the Multiple Procedure Indicator when the procedure code is reported bilaterally with amodifier 50 or on separate lines with modifiers LT and RT for the same structure."

Not sure what MAC area you are in but here is an example: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56681
"When reporting CPT codes 64479 through 64484 for a unilateral procedure, use one line with one unit of service. For bilateral procedures regarding these same codes, use one line and append the modifier-50."