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CPT 64561- Which modifier is correct?

  1. Smile CPT 64561- Which modifier is correct?
    Medical Coding Books
    My office is now doing these temporary placements. The office manager is coding 64561, 64561-50 or 64561-LT and 64561-RT, when there are two placements to determine where to put the permanent one. The permanent is coded with 64581. Both Medicare and BCBS are denying the second one. I suggested using the 51 modifier. Does anyone have any input on this. This is a fairly new procedure in my office and I would like to get the billing right.
    Last edited by vmnickerson; 02-14-2008 at 07:23 PM.

  2. #2

    I was told by Medicare never to bill for a bilateral procedure using two line items using a -50 modifier because in essence, you are then billing for a total of 3 units. Does that make sense?

    If you're billing for two units of this code, how about billing one line item with a -50 modifer?
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  3. #3
    I work for a ASC facility; I not sure if this would apply on a physician setting but I got this information from the MLN (Medicare Learning Network)matters Number SE0742 recently via email. Hope this helps!!

    Billing Bilateral Procedures
    Bilateral procedures should be reported as a single unit on two separate lines or with 2” in the units field on one line, in order for both procedures to be paid. While use of the -50 modifier is not prohibited according to Medicare billing instructions, the modifier is not recognized for payment purposes and if used, may result in incorrect payment to ASCs. The multiple procedure reduction of 50 percent will apply to all bilateral procedures subject to multiple procedure discounting.

  4. #4
    St. Louis, Missouri
    Medicare wants you to bill bilateral procedures on two lines with rt and lt modifiers. They will deny the claim if billed as one line with a 50 modifier.

    Melissa Blow, CPC

  5. Question I need additional info on 64561, modifier 51
    Thank you to all of you that replied to my question. I really believe the problem is with classifying this as a bilateral. They are running to leads, to see which side would work better for the permanent placement. Can I use modifier 51, or should I continue to submit the bilateral?

  6. Default
    thanks for replying. I think these two line should be coded as multiple procedures, mod 51, not bilateral. Let me know any info you may have on this. Thanks, Vivian

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