Wiki To use a Modifier 50 or Not to use a Modifier 50??

[blane]

As many of you know, the US Breast has changed. In the CPT Manual the code doesn't say anything about bilateral. I billed Medicare using a Mod 50 with this code, and was denied. All research I have done, states that with Medicare you would use the 50. LOL Please give me your input on this matter. Thank you.

 

[BenCrocker]

Was the US done on both breasts or just one? If just one use -LT or -RT instead.

 

[blane]

It was performed on both the LT and RT. But Medicare is denying the use of Mod 50.

 

[mhstrauss]

It was performed on both the LT and RT. But Medicare is denying the use of Mod 50.

The 2015 CMS RVU file shows that both US Breast codes should allow for bilateral reimbursement. If your MAC is denying the claim with modifier 50, maybe try 1 unit on 2 separate lines, with "LT" on the first, and RT/XS on the second ? Just a suggestion, as I don't use these codes in my clinic. But it may work

HTH!

 

[blane]

Thank you so much mhstrauss! I will give it a try.