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allenka

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I have a claim that was billed with 64561-LT and 64561-RT. Medicare paid for 64561-RT and denied 64561-LT due to UNITS>MUE MAI= 3. Can this be billed with both right and left modifiers or should this have been billed as bilateral?
Thanks in advance
 
There are many ways to bill Bilateral procedures. Medicare requires 1 surgical line with CPT and modifier 50.

Some carriers want 2 lines with one with mod 50. Some want separate lines with RT, LT. You just need to remember what each carrier prefers. Most follow the Medicare rule.
 
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Novitas, our Medicare carrier, will take the LT/RT modifier on separate lines. Who is your carrier? 64561 can be billed with LT/RT and you are correct, the mue is 3. I would call Medicare and opt for a telephone reopen, I have to do this a lot to have claims reprocessed correctly.
 
I'm not sure what regions this applies to but here their Bilateral policy for commercial. I assume they apply the same for Medicare

https://www.unitedhealthcareonline....Html/ReimbursementPolicies/Bilateral_2015.pdf

Q: What is the most appropriate way for a physician or other health care professional to bill
UnitedHealthcare for a Bilateral Procedure?
A: The procedure should be billed on one line with a modifier 50 and one unit with the fullcharge for both procedures.
 
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