Wiki Mediccare denial for 65855

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leren44

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We billed 65855 RT for a trabeculoplasy of the right eye and Medicare has denied stating the procedure modifier is inconsistent with the procedure code or a required modifier is missing. What am I missing?
Thanks for any input.
 
65855

Hi, 65855 definition changed-it is now considered a bilateral code, therefore RT/LT is not needed. Try resubmitting without modifiers.
 
65855

It is still billed with mod. Rt/Lt and is a unilateral code. The words "one or more session" have been deleted from it's description. Was the right eye billed during the global period of left eye(10 days). If yes then you need to add 79.
 
Response to Medicare denial for 65855

Hi,
We have been dealing with the same denial issue with Medicare since the beginning of the year and I have actually called about it. They said that it is a CMS issue, Medicare is waiting on directives for this specific CPT code. So it's not really a modifier issue, it's a CMS issue. As of 3/30/16 this issue has not been resolved. Hope this helps!
 
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