Wiki Multiple 64455 denied by Medicare.

[Tgauron@gmail.com]

Hello, I have a claim that we billed out an office visit 99213 25, injection J1030 , and 64455 on 4 lines with different toe modifiers and a two lines had mod 59. All 4 lines are denying for missing procedure modifier. Can any one tell me what I am doing wrong? I have been researching like crazy with no luck. Thank you for any help.

 

[sls314]

Hello, I have a claim that we billed out an office visit 99213 25, injection J1030 , and 64455 on 4 lines with different toe modifiers and a two lines had mod 59. All 4 lines are denying for missing procedure modifier. Can any one tell me what I am doing wrong? I have been researching like crazy with no luck. Thank you for any help.

You can't bill that many units of 64455. It's not a per injection code. The MUE is one unit per day.

Note the plural injection(s) and nerve(s) in the code description:

64455

Injection(s), anesthetic agent(s) and/or steroid; plantar common digital nerve(s) (eg, Morton's neuroma)

However, it is a bilateral eligible code. If the services were performed bilaterally, you can bill to Medicare on one line, one unit, with a 50 modifier.

From the CMS publication https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1777CP.pdf

If a procedure is authorized for the 150 percent payment adjustment for bilateral procedures (payment policy indicator 1), the procedure shall be reported on a single line item with the 50 modifier and one service unit. Whenever the 50 modifier is appended, the appropriate number of service units is one.