Question Modifier 76

[sweetladyde]

Has anyone used modifier 76 for a bilateral cerumen impaction? My new employer is insisting that is the only way Medicaid will pay that service. But obviously the description for modifier 76 does not apply

 

[michellem9993]

the codes used for cerumen impaction 69209 unilateral and 69210 bilateral, these codes wouldn't need a modifier as the laterality is included in the code description. You could also reach out to your state's Medicaid and see how they want it billed.

 

[brucep]

Both 69209 and 69210 are unilateral codes. Per CMS, 69209 is reimbursed at 150% with modifier 50, but 69210 will only be reimbursed at 100% even when performed bilaterally, as CMS feels the physiologic processes that create cerumen impaction likely will affect both ears,” according to the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS). So, CMS regards the service as inherently bilateral and modifier 50 should not be appended. Modifier 76 signifies a repeat service after an initial service on the same day. So, unless you are reporting that the service was repeated twice on the same day, you should not use 76.