Wiki Medicare bilateral reimbursement

[KMCFADYEN]

Is anyone having problems with Medicare bilateral reimbursement. Specifically, we are billing large joint injections (20610) with a 50 modifier to Palmetto GBA JII. They are supposed to reimburse at 150% but are only reimbursing for a single injection.

 

[johnmeyer]

We've always had issues with mod -50 with 20610. We've had success with breaking them into two injections (20610-LT, 20610-59-RT). You'd think it wouldn't be necessary since mod -50 is for bilateral anything, but Medicare and our private carriers deny claims with 20610-50 on them.

 

[KMCFADYEN]

We ave recently been getting rejections from medicare for billing 2 lines (RT and LT) and have been forced to bill bilateral (50). When we bill one line bilatteral, the AR dept even increases charge amount but they are still only reimbursing for a single side. W have put a call in to Palmetto to find out what can be done.