Medical Billing Forum

Coding => Coding => : Cpatel August 02, 2016, 04:55:29 PM

: Bilateral CPT 69210
: Cpatel August 02, 2016, 04:55:29 PM

Hello,

We are getting rejections from Medicare for 69210 with 50 modifier. Per coding guide 69210 is unilateral CPT and 50 modifier is allowed for bilateral. Am I billing wrong? Anyone is getting same kind of rejections from Medicare? Please advise.


Thanks
Chhaya

: Re: Bilateral CPT 69210
: kristin August 02, 2016, 10:07:06 PM

I have seen a lot of discussion about this on another forum, and the last thing I heard was that Medicare will simply not pay for this when done on both ears at the same time. They even put it in the Federal Register. Their stance is that the chances of it being done on both ears is 10% of the time, and they have factored enough RVU's into just billing it once to pay for both ears.

If they have since changed their stance, I have not heard they did. Some other payers have the same stance, I think UHC is one of them.

: Re: Bilateral CPT 69210
: PMRNC August 03, 2016, 10:07:19 AM

Kristen is right, most payers follow Medicare guidelines only paying for one ear on one day. My ped's do this procedure quite a bit and very rare they do both ears same day, but I've seen where the provider had the patient come back the next day or within 2 days for the other ear. Occasionally when both ears are bad we will bill for both ears using modifier 50 appended to the second ear (2nd claim line)

 

: Re: Bilateral CPT 69210
: Cpatel August 26, 2016, 02:03:21 PM

Thanks for replies. I found on CMS that Medicare has calculated RVU for 69210 at 150% so will only pay for 1 unit.

Thanks