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Is LT/RT modifiers allowed for 37242 & 37244 if performed on left and right sides? Codify modifer crossref from CPT 2022 (AMA) does NOT list LT/RT modifiers, however CMS policy on sourcing rationale: 280 indicates:
The CMS recommends the use of modifiers LT and RT when:
1. the modifier adds more information regarding the anatomic site of the procedure
2. the modifier helps to eliminate the appearance of duplicate billing
3. the modifier helps to eliminate the appearance of unbundling.
I know there are some cases it's not appropriate but I am looking for clarification if there is a specific source that provides reasoning that LT/RT is not appropriate for these (2) codes when PAE is done on left and right side on same session.
example: 37242 & 37242/XS or 59 performed on left side ..... then 37242/XS or 59 performed on right side.
example: 37244 & 37242/XS or 59 performed on left side... then 37244/xs or 59 performed on right side.
We are not using anatomical modifers to separate the sides however CMS indicates it is appropriate, Can you provide details why it is not?
Thank you!
The CMS recommends the use of modifiers LT and RT when:
1. the modifier adds more information regarding the anatomic site of the procedure
2. the modifier helps to eliminate the appearance of duplicate billing
3. the modifier helps to eliminate the appearance of unbundling.
I know there are some cases it's not appropriate but I am looking for clarification if there is a specific source that provides reasoning that LT/RT is not appropriate for these (2) codes when PAE is done on left and right side on same session.
example: 37242 & 37242/XS or 59 performed on left side ..... then 37242/XS or 59 performed on right side.
example: 37244 & 37242/XS or 59 performed on left side... then 37244/xs or 59 performed on right side.
We are not using anatomical modifers to separate the sides however CMS indicates it is appropriate, Can you provide details why it is not?
Thank you!