Wiki CPC, Billing

[Dsmith07]

Can you bill 76942 with modifier 50 or with 2 unit and received reimbursement from Medicare or Private payers.

 

[KMCFADYEN]

Check the policies. Our are Medicare contractor is Palmetto GBA and they only allow one unit billed for 76942. As for the private payers, you will nee to check their polices as well. We submit as units not with modifier 50 for the payers that allow it.

 

[ollielooya]

I'm with Kelly on this one. Our carrier is NGS and we are allowed one unit per the MUE's. The NCCI directives = 1 unit per DOS. There are some private payers that have paid for more than one unit. In those cases billing enters two separate line items with one unit each and usually chart notes are requested/supplied.

 

[kimfifer]

CPT codes 76942,77002,77003,77012, and 77021 describe radiological guidance for needle placement by different modalities. CMS payment policy allows one unit of service for any of these codes at a single patient encounter regardless of the number of needle placements performed. The unit of service for these codes is the patient encounter, not the number of lesions, number of aspirations, number of biopsies, number of injetions or number of localizations.

NCCI Policy Manual ...Chapter 9...Radiology Services....