Wiki 34812, 34812 -59 vs 34812 -50

[tawana76]

HELP me please. I am trying to bill for 34812 bilateral. According to the CPT manual, it needs to have the -50 modifier which I agree; however, the company I work for refuse to add -50 modifier due to it NOT be a fee- affecting modifier. I don't know how else to bill this code, please advise!

 

[jesse.chavez@dielp.com]

well not to sure if im understanding... your company refuse to use modifier 50 because the second line items is paid at 50%.." first line item at 100%" so your company bills 34812 34812 -59 so you can charge exampl 300 + 300 instead of bundling 34812-50 at lets say 300 and get paid 150% of that charge.? but even then insur. company might correct it and post it as a bundled service..or straight deny claim...
so depending on insur company? Medicare does not like claims to have example 27447,27447-50. they only want one line item 27447-50 and some insur. companys like 27447-Lt 27447-Rt. hope this helps

 

[tawana76]

I know the code is best considered with the insurance 34812 -50. But since its not fee affecting, the company I work for won't add -50 modifier. I need to know how I can get around this. My claim rejected when I billed 34812 / 34812 -59. Medicare is denied it: The number of Days or Units of Service exceeds our acceptable maximum

All the other line items paid, but two with the 34812 and 34812 -59 denied for the reason above.

I don't know how else to bill this so it will get paid.

 

[mitchellde]

The 50modifer does affect the fee, how can your people say it does not. The only way to bill bilateral to Medicare is one line with the 50 modifier and one unit. The way they are instructing you is getting 0 dollars so it is better to receive 150% of the fee instead of 0% of the fee!

 

[jasonrme]

When we bill Medicare 34812 50 and double the fee. Medicare payments are paid only for 1 34812. Any guidance on how to receive double the payment? Also, we billed BCBS 34812 51 and 34812 51 50 and they paid both lines; Medicare is secondary and denied the claims. Any suggestions as the claim was billed correctly for the primary claim.