# How to bill a TF with additional levels for Humana



## Rbilling (Aug 3, 2016)

Humana requires all levels to have a location modifier. For example if my provider preformed the following injections:
right L2-L3, left L4-L5 and bilateral L3-L4 Transforaminal ESI 
we would bill most carriers as follows

64483-50 / 64484 2 units

but Humana wants the additional levels to have a location modifier, so how would this be billed to Humana?

64483-50 / 64484-50 ?
 I know that the additional levels are not on the same location but it was done RT/LT. If it was LT/LT or RT/RT I know we would do 2 units but since it is not I feel my only option is 50 for bilateral. I am correct in thinking this? our would we bill:
64483-50 / 64484-RT / 64484-LT?


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## danskangel313 (Aug 7, 2016)

Have you tried appealing the denial? 

Technically when you add a modifier to a parent code, it will get applied to the add on code. So if you're billing 64483-50, 64484 x 2, to some payers that may be translated into 64483-50, 64484-50, 64484-50, which might be what Humana is doing. It would be inappropriate to bill the L2-L3 and L4-L5 as bilateral for obvious reasons. It would also be inappropriate to bill 64484 with RT or LT mods unless you change 64483 to RT LT as you can't have conflicting modifiers (But the guidelines say to use 50, so RT/LT wouldn't be right anyway). You could have 64483, 64484 x 3, but that goes against the bilateral notation.

I'd appeal this with the chart documentation. What you billed seems to be the only option. There's really no way to do what they want you to do without going against CPT guidelines or unnecessarily bumping into MUE edits. Personally, I'd include that information in my appeal, and I'd probably also attach a copy of the CPT guidelines, just to make a point.


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## KMCFADYEN (Aug 8, 2016)

Check your denial reason.

Assuming that Humana is a Part B replacement...
There is an LCD for this in our state (VA) as well as many others that only allows for 2 levels per session;

From LCD L35148:
_Levels per session

1. No more than two transforaminal injections may be performed at a single setting (e.g. single level bilaterally or two levels unilaterally)
2. One caudal or lumbar interlaminar injection per session and not in conjunction with a transforaminal injection.

Frequency with criteria

1. No more than 3 LESIs may be performed in a 6-month period of time.
2. No more than 6 epidural injection sessions (therapeutic ESIs and/or diagnostic transforaminal injections), inclusive of all regions and all levels (cervical, thoracic, lumbar, etc.), may be performed in a 12-month period of time. If a pain practitioner performs epidural injections in the cervical and/or thoracic regions at the same time frame in the patient as LESI's, the practitioner should be particularly cognizant of the cumulative steroid dose to the patient from all levels injected.
3. If a prior LESI provided no relief, a second LESI is allowed following reassessment of the patient and injection technique._

SO, we can only bill
64483 50
_*OR*_
64483 Rt _OR_ LT
64484 RT _OR_ LT


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