Wiki RE: Use of Modifier 50 with CPT code 95930

[shofner14]

RE: Use of Modifier 50 with CPT code 95930

Can modifier 50 be used w/CPT code 95930 for the visual evoked response test? I do not understand the CMS payment indicators 1 and 2 for use
of modifier 50 and my provider performed the eye test bilaterally.

 

[mhstrauss]

Can modifier 50 be used w/CPT code 95930 for the visual evoked response test? I do not understand the CMS payment indicators 1 and 2 for use
of modifier 50 and my provider performed the eye test bilaterally.

I don't believe you can use modifier 50; according to the RVU files, it has an indicator of "2", which means (emphasis added by me):

"If the indicator is "2," the 150 percent payment adjustment for bilateral procedures does not apply. RVUs are already based on the procedure being performed as a bilateral procedure. If 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 with a 2 in the units field), base payment for both sides on the lower of (a) the total actual charges by the physician for both sides or (b) 100 percent of the fee schedule amount for a single code.
Example: The fee schedule amount for code YYYYY is $125. The physician reports code YYYYY-LT with an actual charge of $100 and YYYYY-RT with an actual charge of $100. Payment would be based on the fee schedule amount ($125) since it is lower than the total actual charges for the left and right sides ($200). The RVUs are based on a bilateral procedure because: (a) the code descriptor specifically states that the procedure is bilateral; (b) the code descriptor states that the procedure may be performed either unilaterally or bilaterally; or (c) the procedure is usually performed as a bilateral procedure."

 

[shomeyj12]

You cannot - it is not an approved modifier for 95930..

-S