29848-50

[shortee3810]

We had a doctor who done bilateral carpal tunnel release on same day for BCBS Medicare which denied because per the MUE you only can do 1 per day. In the past we have gotten paid for both on the same day. I wanted to know if anyone else billed bilateral on the same day and gotten paid for it recently?

 

[amyjph]

According to the MPFS search, 29848 has a bilateral indicator of 1 meaning: 1 = 150% payment adjustment for bilateral procedures applies. If a code is billed with the bilateral modifier or is reported twice on the same day by any other means (such as with RT and LT modifiers or with a 2 in the units field), payment is based for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides or (b) 150% of the fee schedule amount for a single code.If code is reported as a bilateral procedure and is reported with other procedure codes on the same day, the bilateral adjustment is applied before applying any applicable multiple procedure rules.

How did the bill go out? 29848, one line, one unit, modifier 50 with both RT & LT dx codes?

The MUE is one but the MAI is 2:

Effective: 1-Jan-24

The MUE for 29848 is 1

The MAI is 2 Date of Service Edit: Policy

MUE Rationale: CMS Policy

https://www.anthem.com/dam/medpolicies/abcbs/active/guidelines/gl_pw_e001256.html

Did you check the payer's bilateral surgery policy?
Does the payer have a specific policy that only one CTR can be done per day?
This is a Palmetto example, but you may be able to appeal in this manner provided the regs were followed upon the 1st billing:

https://palmettogba.com/palmetto/jma.nsf/DIDC/89H9LRZECK~Appeals~Filing%20an%20Appeal

 

[shortee3810]

It went out on one line, one unit, with modifier 50 and doubled the fee..