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cpt 69210

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PMBS:
Good morning,

I billed Medicare for cpt 69210.  The procedure was done bilaterally so I used modifier 50.  Medicare denied stating  procedure is inconsistent with modifier or a required modifier is missing.  Missing/incomplete invalid HCPCS.

Any help will be appreciated.

Thank you

Miriam

kristin:
Medicare doesn't recognize 69210 as being a unilateral procedure, although that is the CPT code description. Therefore, they have adjusted their RVU's to reflect the payment to be for one ear, or both ears. You cannot use a 50 modifier on the code with Medicare at all, since Medicare's edits don't recognize it. Bottom line, when it comes to Medicare, whether you do one ear, or both ears, you can only bill the 69210, no 50 modifier.

PMBS:
Thank you

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