Wiki 91 modifier with CPT 82947

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CXZook

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Patient has a total of 8 glucose test repeated on the same date of service. We are billing CPT 82947. Would modifier 91 be added to every 82947 except the 1st 82947 charged? Or does 91 get added the charges that exceed MUE? MUE is 5 so the 6th, 7th, and 8th 82947 that is charged.
 
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Deborah Marsh said:
Hi - This likely will depend on the payer, but it's not unusual to have the instruction to use 91 on the second and subsequent code. In this case you also are dealing with the MUE. Check out this slide from NGS as an example. Slide 38 of https://www.ngsmedicare.com/documen...6-911f-f97f-8a29-d7a6b6f23f79?t=1689879521622

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@Deborah Marsh - thank you for the information. So, in the slide it is stating the claim would be billed with 82947 on 1 line only with a total quantity of 7 no modifiers? Documentation sent to support all 7 units.

Had we only performed/charged 4 82947 and the payer requested modifier we would put 91 on 2nd, 3rd, and 4th 82947?
 
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My understanding matches yours (with documentation for units above the MUE). There are all the usual caveats about payers policy may vary :) The instruction to use separate lines with modifier 91 for repeat tests is common (vs. the single line with multiple units). Here is an example from UHC about 91 on "each additional" test. https://www.uhcprovider.com/content...bursement/COMM-Laboratory-Services-Policy.pdf
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Deborah Marsh said:
My understanding matches yours (with documentation for units above the MUE). There are all the usual caveats about payers policy may vary :) The instruction to use separate lines with modifier 91 for repeat tests is common (vs. the single line with multiple units). Here is an example from UHC about 91 on "each additional" test. https://www.uhcprovider.com/content...bursement/COMM-Laboratory-Services-Policy.pdf
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@Deborah Marsh thank you so much for sharing with me on this topic. Appreciate your responses.
 
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