If anyone has experience on coding for CPT codes 64475 and 64476, I will appreciate your help.
When billing Medicare, I have a Pain Management provider who does MULTIPLE BILATERAL injections utilizing CPT codes 64475 and 64476. In the past, I used to bill these with a RT and LT modifier along with modifier -76 when multiple injections are done. Medicare has denied stating that the -76 modifier is not applicable for these CPT codes. I have also used strictly the 50 modifier (billing all on one line item for Medicare) for bilateral along with unit values based on how many injections the provider had done on each side, bilaterally. This scenario has also been denied, stating that I am unable to bill multiple units for 64476.
Has anyone encountered this before? Does anyone have experience on how to appropriate bill for CPT codes 64475 and 64476?
Thanks in advance.
Jennifer Gauger, CPC
Coding Department Supervisor
- Exam Preparation
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Software / Digital
- Code Lookup (AAPC Coder)
- Practicode (online coding simulation)
- E/M Analyzer
- CPT RVU Calculator
- Health Plan Search (Provider Policies)
- Book Store
- Log In / Join