Wiki 73560 with 50 modifier

[rumfield1959]

Medicare no longer accepts CPT 73560 with modifier 50?? But yet we can bill other xray codes with 50 modifier. Does anyone know about this & do you have documentation supporting this change. I called Medicare & they told me they could only see this internally & could not explain it.

 

[thomas7331]

It looks like this might have been an error - this has been corrected in the physician fee schedule release that is effective tomorrow and is retroactive back to 1/1/16:

https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/Downloads/2016-Apr-IOCE-Summary.pdf

 

[rumfield1959]

I see the code in the PDF file you sent, however, were did you get your info in the sentence you typed?

 

[thomas7331]

If you look up the code on the physician fee schedule, in the initial 2016 version the bilateral indicator for the professional and global fees was changed to '0' from '3' in 2015, whereas the technical was still '3'. In the revised version just published, it is back to '3' for all. I'm not able to find specific documentation of why the change was made, but typically a change like this that affects payment would be published in the PFS final rule with an explanation of the rationale before being put into effect. Since it wasn't, I'm guessing that it was just an error in the file that has now been corrected.