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Bilateral Procedure with Wellcare

  1. #1
    Gainesville, GA
    Default Bilateral Procedure with Wellcare
    Medical Coding Books
    I have a co-worker whom is having a difficult time getting wellcare to pay for bilateral procedures. Is there anyone here that can help me to give her some ideas. She has tried seperate line items, & modifiers and still no payment. She is not having any luck from Wellcare with any suggestions on how to get this paid timely.

    Lisa D

  2. #2
    I work for an ASC and below is some information about bilateral procedures when you billing Medicare. If i'm not mistaken Wellcare goes by Medicare Guidelines...This information might help

    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.

    You can also choose to do the cpt code per line + modifier LT and RT; example: 15823-LT + 15823-RT

  3. Default Bilateral procedures
    I am having a difficult time finding resources on which insurance companies accept the one-line method for reporting bilateral procedures and which insurance companies accept the two-line method for reporting bilateral procedures. I have only confirmed through EOB denials that BCBS accepts the two-line method and Humana accepts the one-line method Does anyone know of any resources that would have this information? I have searched carrier websites, the managed care manuals and nothing specific to this. Thanks for any help!

  4. Default Modifier 50
    The procedure should be billed on one line with modifier 50 and quantity of "1"

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