Wiki Medicare and modifier 50

[mcrossley]

I work for a radiology group and have come across a few denials for bilateral claims we billed on one line with modifier 50. When we rebilled as 2 lines with LT & RT modifiers, the claim paid. Does anyone know for sure if Medicare requires bilateral studies, specifically for radiology billing, to use left and right rather than 50?

 

[bgrasson]

I dont think Medicare/Medicaid like modifiers. We bill 2 lines with RT/LT and that always seems to work-even for most insurances.

 

[thomas7331]

Medicare publishes a bilateral indicator for every CPT code on the physician fee schedule which instructs on how it should be paid when billed bilaterally, and the descriptions on these indicators define this as being when the procedure is "reported with modifier -50 or is reported twice on the same day by any other means (e.g., with RT and LT modifiers or with a 2 in the units field)." So either method for reporting the bilateral procedure should be equally valid.

If your Medicare contractor is paying the code differently with the RT/LT modifiers than they are with the 50 modifier, then I'd have to say that they either have developed some reporting guideline that is specific to your Medicare jurisdiction, or they are not following the Medicare reimbursement policy correctly.

 

[jkyles]

I work for a radiology group and have come across a few denials for bilateral claims we billed on one line with modifier 50. When we rebilled as 2 lines with LT & RT modifiers, the claim paid. Does anyone know for sure if Medicare requires bilateral studies, specifically for radiology billing, to use left and right rather than 50?

Where were the denied services performed? This is a bit off-topic but MACs have recently released new LCDs for chronic pain services that require 50 in the office setting and RT/LT in the ASC. I wonder if it is something like that.