Wiki Medicare 76942 Ultrasound/Needle Guidance

[sopka9476]

I just received a denial from Medicare for improper modifier use on a bilateral 76942 in which I have always itemized out with RT/LT modifiers. Does anyone know if Medicare now wants it differently?

 

[thomas7331]

76942 has a bilateral indicator '0' on the PFS which means that if billed bilaterally or with RT/LT it will only pay the amount for one code. It also has a MUE value of a maximum of one unit per day. This is the same for 2016 and 2017 so nothing has changed that I know of, but your payer may have updated their system to deny the coding differently than they did before.