Bilateral Xray Profee - MITS billing, OH Caid

DiannLG

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Canfield, OH
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Here is an example: patient has "radiologic examination, knee; 1 or 2 views" on both knees, we bill 73560-26 - the catch is that it's Ohio Medicaid, now using MITS online; Although they now accept RT & LT modifiers, they won't accept this on radiology codes, they also will not accept 50 modifier; if you bill 2 separate units, one denies as a duplicate, then I "attach" the medical record in MITS & send it and it still denies; I've tried billing 2 units on one line; I've tried to verify correct billing in every publication I can find, but I cannot find this exact issue
 

cblack712

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I have seen this before with a different payer - have you tried 73560-26 and 73560-26-76? Maine Medicaid also requires the use of 51 on some procedures indicating that it is multiple procedures -- this was the first that I had ever experienced this and I have worked for quite a few state medicaid programs!
 
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