Billing Medicare CPT 67820

[Gayle33]

I am looking for Medicare billing guidelines for CPT 67820.  I have called Medicare and there is not an LCD for this code.
I just received a denial for billing for Rt eye & LT eye (2 lines)  and added modifier 51 to one code (67820-RT, 67820-LT-51) The denial code is CO-151 "Payment adjusted because payer deems the information submitted does not support this many/frequency of service".  The number of days or Units of service exceeds our acceptable maximum.

Thanks, appreciate any information on this.

[kristin]

CMS has an MUE on that code stating that is is medically unlikely that both eyes would be done in the same session/DOS. That said, at least one MAC I found, Palmetto GBA, does allow it to be billed bilaterally on the same DOS, but you have to follow the correct coding rules on billing bilateral procedures, which is to bill the code on one line, with a 50 modifier, at one unit. No RT/LT needed.  And you don't need to bill 51 modifiers to Medicare...they add that modifier on their end automatically to reduce payment on multiple procedures. You can set the price for the one line you do bill at the total for what two separate lines would be, so as not to mess up payment application. Medicare will automatically set the payment at 150% of the allowable on bilateral procedures.

But this only applies if your MAC is like Palmetto, and allows the code to be billed bilaterally with a 50 modifier. If not, you need to appeal their denial of the MUE, and see if they will allow more payment.