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Botox billing

  1. #1
    Default Botox billing
    Medical Coding Books
    Medicare recently updated their policy for reimbursement for 64613 and 64614 now assumning these are inherently bialteral procedures. How to bill for these if only unilateral were performed? Would you append modifier 52 or simply indicate RT or LT?

  2. #2
    Location
    Lexington Kentucky Chapter
    Posts
    105
    Default
    Quote Originally Posted by codergirl3504 View Post
    Medicare recently updated their policy for reimbursement for 64613 and 64614 now assumning these are inherently bialteral procedures. How to bill for these if only unilateral were performed? Would you append modifier 52 or simply indicate RT or LT?
    Check with your carrier: There should be guidelines on how they prefer it to be billed; some will want the second procedure to be billed with a -50 modifier on the second line while others only want the -50 modifier on the one line. (I have seen instances of codes that carriers do not want the -52 appended at all!)

    Hope this helps.

    David Keown, CPC, OCS

  3. #3
    Location
    Everett, WA
    Posts
    886
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    Excellent article on how to bill in this month's Coding Edge's Coding news on p. 8. It explains the use of modifer 52. In addition the usual disclaimer is added to "review your contracts with non-Medicare payers to be sure that you continue to report chemodenervation per the specif payer's requirements."
    We have 31 payers so that will take a lot of work on the front side.

    ---Suzanne E. Byrum CPC

  4. #4
    Default Botox Billing
    Thank you both.

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