tci Part B Insider - 2014 Issue 25

MUEs: Citing Misuse, CMS Changes MUE Rules for Several Bilateral Procedures

Unless modifier 50 works on your code, you’re out of luck. If you’re one of the many coders that has surreptitiously bypassed the medically unlikely edits (MUEs) for bilateral procedures, your luck has run out. CMS has caught onto the fact that many practices are using the RT and LT modifiers (or separate line items with no modifiers at all) to avoid edits on modifier 50, and has instituted new screening edits to ensure that your claims get kicked out when bilateral billing isn’t allowed on a particular code. Background: If you report a bilateral procedure...

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