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Thread: 64493

  1. #1

    Default 64493

    AAPC: Back to School
    Is 64493 subject to the multiple procedure reduction through Medicare?

    For example:

    Would both procedures be paid at the exact same rate, because they are 1 procedure being performed bilaterally?

    Documentation to support would be awesome.

    Tracey Thompson, CPC, CPPM

  2. #2
    Join Date
    Apr 2007
    Nashville AAPC Chapter


    www.cms.gov - fee schedule

    150 percent payment adjustment for bilateral procedures applies. If code is billed with the bilateral modifier or is reported twice on the same day by any other means (e.g., with RT and LT modifiers or with a 2 in the units field), base payment for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides or (b) 150 percent of the fee schedule amount for a single code.
    If code is reported as a bilateral procedure and is reported with other procedure codes on the same day, apply the bilateral adjustment before applying any applicable multiple procedure rules.

  3. #3

    Default Thanks!

    Thank you so much for such an informative response.

    Do you have the link to this information?

    Tracey Thompson, CPC, CPPM

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