Wiki CPT code 15777

[ddcote22@gmail.com]

We are having trouble with Anthem paying this code and was wondering if anyone else was struggling to get 15777 paid. The Mue is one but the code description does allow for bi-lateral procedure. When we bill as bi-lateral Anthem will deny as "exceeds daily limit". If I break out on two lines at one unit each they deny the same way. If we bill with only one unit on one line they will process and pay but I am not sure this is correct coding. If anyone has any thoughts I would gladly welcome the help. Thanks.

 

[kseebeck]

I found this answer: https://www.karenzupko.com/oncoplastic-reconstruction-plastics/

 

[csperoni]

This is regarding add on codes in general, and not specific to 15777.
There was a change in 2020 regarding modifier -50 with add on codes. The guidance was to bill twice, once with -LT and once with -RT, no longer with -50.
However, Medicare did not update their MUE numbers (to my knowledge). I know there is a specific add on code that we perform all the time bilaterally. We still bill it with -50 and I have yet to see a denial from Medicare. With commercial carriers, they all seem to set their own rules. We bill the add on with -50 initially (unless we are aware of a carrier policy stating otherwise). In the rare case it's denied, we rebill with 2 lines for -LT and RT. And appeal with coverletter and notes if the rebill is denied.
Here is another post regarding add-ons and -50.