Wiki CPT 64640 - help with Modifiers

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ChrissyMiodrag

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Hello, I am hoping to find some help. We are billing CPT 64640, which requires and anatomical modifier. Patient is receiving 2 patches on each side, left and right. Novitas is telling us to bill it using the 50 Modifer AND the LT, this is not working as claims are getting rejected by muliple carriers. The 50 Modifier Fact sheet is contradictory as well, it indicates to use both the 50 and LT. Below is how they have suggested we bill it, which is not working. Anyone else having a similar issue?
64640 50/LT
64640 51/RT
 
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Are you billing for the provider claim/1500?
1. Medicare doesn't want the 51 modifier. It also doesn't make sense to append a 51 to a second line of the same CPT because they have the same RVUs so it wouldn't matter which one was 100% or MPR. "Note: Medicare doesn’t recommend reporting Modifier 51 on your claim; our processing system will append the modifier to the correct procedure code as appropriate." https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144532
2. You wouldn't append both a 50 and the RT or LT on the same line. https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144531
3. Also see NCCI Manual https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-1.pdf "ii. If the bilateral surgery indicator is “1,” a bilateral surgical procedure must be reported with “1” unit of service and modifier 50 (bilateral modifier). A bilateral diagnostic procedure may be reported with “1”unit of service and modifier 50 on 1 claim line, or “1” unit of service with modifier RT on 1 claim line plus “1” unit of service and modifier LT on a second claim line."
4. Agree with Susan: Bilateral indicator 1:
Bilateral procedures must be reported with 1 unit of service and the modifier 50. Modifier 50 identifies the service as being performed on both sides of the body. Do not report anatomical modifiers in addition to modifier 50. If more than one bilateral procedure was performed, report the services on one line, the number of units should be adjusted to reflect the number of bilateral procedures that are performed.
Think of it like this, you said, " which requires and anatomical modifier", the 50 is an anatomical modifier, it means bilateral.
Some payers don't follow CMS and may want it done a different way so you would have to check their modifier 50/bilateral procedure policy.
 
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