98926 with 50 modifier denial from Horizon NJ Health

[Biller2023]

We billed 98926 with 50 modifier since the procedure was performed bilaterally however Horizon NJ Health denied stating "The procedure code is inconsistent with the modifier used or a required modifier is missing".

so how do we bill this claim and get paid?

 

[sumathip78@yahoo.com]

98926 is for 3-4 body regions involved. Body regions referred to by the CPT book are cervical region, thoracic region, lumbar region, sacral region, pelvic region, lower extremities, upper extremities, rib cage region, abdomen and viscera region.
98925 - 1-2 body regions involved
98927 - 5-6 body regions involved
98928 - 7-8 body regions involved
98929 - 9-10 body regions involved

 

[EditaPetrosyan]

bilateral modifiers are not applicable to osteopathic manipulative treatment codes. These services are reported based on the number of body regions treated rather than laterality, so the bilateral concept does not apply.