Question Which modifier to use for 21080

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plano, TX
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I am trying to bill the finals for our patients for CPT 21080. We are doing both upper arch and lower arch on same day (this is MEDICAL in nature, not dental). It looks like Medicare MUE is for 1 unit per day only, but can I bill for 2 units on same line with 76 modifier or do 21080 per line twice? The diagnosis codes differ as each arch has different atrophy diagnosis codes. Ex: upper arch dx would be K08.26 and lower arch would be dx K08.22. Any help is appreciated!
 

Deborah Marsh

Networker
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35
Location
Southern Pines, NC
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Hi - This isn't my specialty area, but a couple of thoughts. First, the MUE has an MAI (MUE adjudication indicator) "2." That means it's an absolute DOS edit, and it's not one you can override. There's more information about MAIs in the NCCI manual, chapter 1, starting around p. 36. https://www.cms.gov/files/document/chapter1generalcorrectcodingpoliciesfinal112021.pdf

The other thought is that you mention upper and lower arch. Is a different code appropriate for the lower arch, like 21081?

Best of luck!
 
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