atiya1976
New
Hello,
I have a question regarding billing: 1unit of L8619 (cochlear implant, external processor) with a bilateral DX H90.3 (bilateral sensorineural hearing loss) with one anatomical modifier - RT.
Patient is either using only one processor on the RIGHT side, or the RIGHT processor is being replaced because of being damaged, and the LEFT side is still in use.
Some payors, mainly BCBS (various states) are denying for mismatch modifier with DX. These payors are requiring a LT and RT modifier on the same line, stating it is a bilateral DX.
When adding both the LT and RT modifiers, for the one processor the claim will pay. I know this claim edit/denial is payor specific.
Has anyone else come across these denials with other HCPCS codes? If so, how do you proceed?
I have a question regarding billing: 1unit of L8619 (cochlear implant, external processor) with a bilateral DX H90.3 (bilateral sensorineural hearing loss) with one anatomical modifier - RT.
Patient is either using only one processor on the RIGHT side, or the RIGHT processor is being replaced because of being damaged, and the LEFT side is still in use.
Some payors, mainly BCBS (various states) are denying for mismatch modifier with DX. These payors are requiring a LT and RT modifier on the same line, stating it is a bilateral DX.
When adding both the LT and RT modifiers, for the one processor the claim will pay. I know this claim edit/denial is payor specific.
Has anyone else come across these denials with other HCPCS codes? If so, how do you proceed?
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