Neurology & Pain Management Coding Alert

Question: Should I use modifier 50 with 64614 if the neurologist treats the right leg and right arm during the same visit?


Illinois Subscriber


Answer: No, you should not use modifier 50 (Bilateral procedure) for chemodenervation services performed on the right leg and right arm. The use of modifier 50 is applicable only to services and/or procedures performed on identical anatomic sites, aspects, or organs - for example, the right knee and left knee.

Whether you can report multiple units of 64614 for chemodenervation to multiple sites depends on the payer and the rules that they follow. You'll discover that the American Medical Association's CPT Assistant advice doesn't agree with many Medicare LCD/LMRPs.

The February 2005 issue of CPT Assistant responded to a question regarding the appropriateness of adding modifier 50 to 64614 (Chemodenervation of muscle[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) when the physician treats both extremities at the same session. The answer, in summary, was that you should not use modifier 50 and that you should report this code only once within a single session for chemodenervation of any of the areas in the code description.

This answer, however, varies with many Medicare LCD/LMRPs that frequently allow one unit of service per each contiguous limb or trunk.

That means that if a provider performed chemo-denervation on the right leg and right arm, many Medicare carriers will allow you to report two units of service. They count multiple injections within a single contiguous unit as one unit.