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Thread: Modifier 76 and CPT code 64450

  1. #1

    Default Modifier 76 and CPT code 64450

    Is it appropriate to use modifier 76 on CPT code 64450? My provider is doing a diagnostic bilateral L5, S1, S2, & S3 dorsal primary ramus injection under fluoroscooic visualization. Claim was billed 64450-507659
    64450-507659
    64450-507659
    Medicare is denying the second and third line as duplicates. Please help.
    As always Thanks

  2. #2
    Join Date
    Apr 2007
    Posts
    1,474

    Default

    I assume you are describing the lateral branches w/ 3 levels performed bilateral. When billing WPS Medicare J5, I would not be able use 76 modifier on a surgical procedure code and I would not be able to use the 59 modifier on code pairs that are not subject to NCCI edits. So if I was billing this I would have to bill as such

    64450-50
    64450-50 51 additional note two additional levels performed Bilateral
    64450-50 51

    The additional note on the claim is important, but this might be the type of procedure that requires an anticipated denial with planned appeal for review that this a per level procedure and not a duplicate.

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