Wiki 92014 & 76512 bundled?

[southbaycoder]

I have billed Molina medical group through medicaid and Line (92014) was reimbursed however line (76512) was denied with "The procedure code is inconsistent with the modifier used or a required modifier is missing". NO MODIFIERS WHERE APPENDED TO EITHER LINES. Any help rendered would be greatly appreciated...

 

[Cheezum51]

Since 76512 isn't classified as a bilateral test, you would have to use the RT, LT or 50 modifier with it.

Tom Cheezum, OD, CPC, COPC

 

[Abodie07]

I agree with Cheezum, we have to use an anatomical modifier with 76512 bc it is not a bilateral code. That's why it's denying for incorrect modifier, because one is missing.

 

[mvallejo0902@gmail.com]

Insurance denying 76512 for "the procedure is outside scope of practice" this was billed with 9921 by MD (ophthalmologist) not OD, does anyone know if 76512 requires modifier?

 

[HEakin]

Insurance denying 76512 for "the procedure is outside scope of practice" this was billed with 9921 by MD (ophthalmologist) not OD, does anyone know if 76512 requires modifier?

Depending on payer, 26 for professional component or TC for technical component must be used with LT/RT/50.

 

[narredondo1103@gmail.com]

Another suggestion is to check with Molinas billing coding policy. Most likely they follow the medicaid/ mcal guidelines for your state. This should guide you to the modifiers they allow or require for that CPT code.