Wiki Bilateral injections and billing with united healthcare

[kteabilling@gmail.com]

For the last year I have been fighting UHC with bilaterial eye injections and how they are billed. With CMS we bill two lines of the medication with modifier JZRT/JZLT and then it it paid. UHC has at one point told us and other offices they want the J code on one line with the JZ50 modifiers and then change the amount of units. We started doing that and then it was denied stating invalid use of JZ modifier. Then we were told they want two lines with just JZ on one and JW on the other. The problem with that is we do not waste any of this medication so the use of the JW modifier is not valid. Then I was recently told to resubmit all bilateral eye injections on one line with just JZ modifier not eye modifier or modifier 50, change units and bill. WEll I did that and they are starting to be denied. I have filed another case with the provider relations department with UHC.

Anyone else having these issue?

 

[Gator]

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Bilateral-Procedures-Policy.pdf

The J codes that get the JZ mod should not have a side RT/LT/50 modifier. Those mods would be for the administration codes. The J codes should have the units adjusted to cover the total amount of the drug administered to both eyes and then the JZ or JW modifier.