Wiki CPT 38792

[steden]

Do you need RT/LT modifier attached with CPT 38792?

 

[Deborah Marsh]

Hi - Use of RT/LT and 50 can vary by payer. But if you mean does bilateral policy apply, then it does on the MPFS. 38792 has a bilateral indicator of "1," meaning "150% payment adjustment for bilateral procedures applies. If a code is billed with the bilateral modifier or is reported twice on the same day by any other means (such as with RT and LT modifiers or with a 2 in the units field), payment is based for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides or (b) 150% of the fee schedule amount for a single code."

CGS says if there's a bilat indicator of "1," you can use RT and/or LT. E.g., search LT at https://cgsmedicare.com/medicare_dynamic/modifiers_ky/modifiers_ky/search.aspx

 

[steden]

Thank you!