20610 bilateral - help with modifiers and units

[houmaob1714]

What is the correct way to bill Medicare, Blue Cross Blue Shield, United Healthcare, Humana, etc. for 20610 bilateral? Would it be 20610-50 with 1 or 2 units or separetly with RT and LT modifiers?

 

[JWEILER]

20610 bilateral

I believe that Medicare, BCBS and Humana require bilateral procedures billed on one line using the -50 modifier and one unit. Be sure to double your fee, though. United generally likes them on separate lines. Hope that helps.

 

[houmaob1714]

Yes thank you very much. It is my understanding that Medicare will pay 150% of the allowed amount billing with modifier 50, 1 unit. Is that correct?

 

[gr8gal61]

Yes that is how we bill Medicare, modifier 50 with 1 unit

Yes thank you very much. It is my understanding that Medicare will pay 150% of the allowed amount billing with modifier 50, 1 unit. Is that correct?

 

[houmaob1714]

If an injection is given for both knees and both shoulders, would I bill the following way:

20610 1 unit, 50 modifier, double the fee (knees)
20610 1 unit, 50-51 modifier, double the fee (shoulders)

Or does it need to be all on one line: 20610 2 units, 50-51 modifier, knees & shoulders, double the fee

 

[mp19777]

I was told we need to it look like this:

20610-RT
20610-LT

 

[jkyles@decisionhealth.com]

Hi there, Medicare wants 50 but private payers will vary so you'll need to check the plan's medical policy.