by Wyn Staheli, Director of Content - innoviHealth
Dec 30th, 2019
If reporting bilateral procedures and services wasn't confusing enough due to having more than one way to report this on the claim, now there's a new rule for DME suppliers. Medicare requires the right (RT) and left (LT) modifiers to be used with orthosis base codes, additions, and replacement parts. As of March 1, 2019, Medicare began denying claims for bilateral supplies when the claim included both the RT and LT modifiers on the same claim line, but only for certain supply codes. The preferred method is to bill each item on a separate claim line where one line includes the supply code with modifier RT and the second line includes the supply code with modifier LT as shown in the following example:
This change affects all DME jurisdictions, but as mentioned above, ONLY for certain supplies as found in the following articles:
- Ankle-Foot/Knee-Ankle-Foot Orthoses (A52457)
- External Breast Prostheses (A52478)
- Eye Prostheses (A52462)
- Facial Prostheses (A52463)
- Knee Orthoses (A52465)
- Lower Limb Prostheses (A52496)
- Orthopedic Footwear (A52481)
- Refractive Lenses (A52499)
- Surgical Dressings (A54563)
- Therapeutic Shoes for Persons with Diabetes (A52501)
- Wheelchair Options/Accessories Policy Article (A52504)
- Standard Documentation Requirements Policy Article (A55426)
Note that this change only applies to the reporting of bilateral modifiers RT and LT. The use of other required modifiers (i.e., KX, GA, GZ) still applies.
For information about reporting bilateral procedures/services, CLICK HERE.
About Wyn Staheli, Director of Content - innoviHealth
Wyn Staheli is the Director of Content Research for innovHealth. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.