Question 20610 multiple units

[zclens2015]

We are getting denials for injections with Medicare. Example: Left shoulder and right knee injections. We would bill 20610-LT,20610-XS,RT. We have also tried 51 and 59, all get denied. One of our AR reps called and was told to use modifier 50 even though it is a shoulder and knee. Anyone else have experience with this? Using a 50 just doesn't seem correct.

 

[CBLENNIE]

What reason codes are being used by Medicare to deny these charges, please include all CARC & RARC codes on your remit. Also, are both injections being denied, I think both are based on how you worded your post, but I just want to make certain what exactly is being denied? Also, who is your Medicare Part B MAC?

 

[amyjph]

Google Modifier 50 fact sheet and CMS and/or your MAC such as Palmetto, Novitas, FSCO, etc.

 

[lgraham@ospc1579.com]

I had this happen with a claim for Connecticare. From what I understand even thought it is (2) separate anatomical sites they are RT/LT & they want it billed bilaterally regardless as they are opposite sides.

 

[mjonas]

We have been getting denials for our NJ clients for the same thing. Was told by the Medicare rep that we use 50 modifier regardless if it is different like shoulder, knee etc. We have since sent corrected claims and been paid with the modifier 50.