Wiki Botox cpt 64612

[aparscal]

Learning to bill botox, so my question is. Is it appropriate to 64612.50 if the provider only injected one of the muscles bilaterally? I know MCR will only allow payment for one injection per site regardless of the number of injections.

Provider did a total of 45 units injected and 5 discarded.
there were multiple muscles injected on one side, but the corrugator supercilli muscle was injected with 2.5 in each side. now if I add mod 50 to 64612 is that implying that all the muscles were injected bilaterally?

 

[mhstrauss]

Learning to bill botox, so my question is. Is it appropriate to 64612.50 if the provider only injected one of the muscles bilaterally? I know MCR will only allow payment for one injection per site regardless of the number of injections.

Provider did a total of 45 units injected and 5 discarded.
there were multiple muscles injected on one side, but the corrugator supercilli muscle was injected with 2.5 in each side. now if I add mod 50 to 64612 is that implying that all the muscles were injected bilaterally?

IMO, It is appropriate to use modifier 50 in this situation, since injections were performed bilaterally, even though only one of the muscles was bilateral...I see this often for both the facial and neck injections we perform. I've never come across any official guidance for this though; if I find anything, I will post here.

 

[ollielooya]

Meagan, thanks for posting this! I wanted to jump in and answer, but had no authoritative documentation other than what you just shared. In the past, we billed with the modifier 50 for situations such as this, and received the discounted payment for the second side. I know for a fact there are two well qualified folk to address this on the forum and hope they respond to this thread.