Specifically, modifiers LT and RT should be used to identify procedures that can be performed on contralateral anatomic sites (such as bones, joints), paired organs (such as ears, eyes, nasal passages, kidneys, lungs, ovaries), or extremities (such as arms or legs).
When to use RT and Lt modifiers?
Finally, modifiers LT and RT may be used to provide location-specific information for those services defined either as unilateral or bilateral, such as ablation of soft tissue codes 30801 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial. If this procedure were …
When to use a modifier for a radiology procedure?
· The right (RT) and left (LT) modifiers must be used when billing two of same item or accessory on the same date of service and the items are being used bilaterally. Current instructions for billing products to be used bilaterally instruct suppliers to use the RTLT modifier on the same claim line and indicate two (2) units of service.
Do all CPT codes require laterality modifiers?
· Best answers 0 Sep 23, 2010 #2 As indicated in §20.6.2, modifier -50, while it may be used with diagnostic and radiology procedures as well as with surgical procedures, should be used to report bilateral procedures that are performed at the same operative session as a single line item. Modifiers RT and LT are not used when modifier -50 applies.
Can Lt and RT be used on the same service line?
· CPT® codes that are designated in their description as “unilateral or bilateral” do not require additional laterality modifiers. Claim lines for CPT®/HCPCS codes requiring use of …
Does Medicare accept modifier LT and RT?
Several DME MAC LCD-related Policy Articles require the use of the RT and LT modifiers for certain HCPCS codes. The right (RT) and left (LT) modifiers must be used when billing two of same item or accessory on the same date of service and the items are being used bilaterally.
What is modifier LT and RT?
Modifiers LT and RT provide supplemental information for procedures performed on paired structures such as the eyes, lungs, arms, breasts, knees, etc. These modifiers don't directly affect payment, but provide vital information to identify the location of a service.
What modifier do you use for an X-ray?
Modifier FX designates X-ray imaging services that are taken using traditional x-ray film rather than digital radiography. Claims for X-rays using film are to include modifier FX.
What is the LT modifier used for?
This modifier is used to identify procedures performed on left side of body. Be sure to determine if HCPCS modifier LT is applicable for a particular procedure code. It does not affect allowed amount on a claim; however, lack of a required modifier can cause denials or development to occur.
How do you bill bilateral procedures for Medicare?
Medicare requires that when bilateral procedures are billed, they should be billed with one unit on one line with the 50 CPT modifier. The amount billed should reflect the cost of both the left and right side.
What is the bilateral procedure rule?
Definition: A surgical procedure is considered bilateral when the same procedure is performed on both sides of the body. Common anatomical sites for bilateral surgical procedures are extremities, eyes, ears, and breasts.
What is the difference between modifier 26 and TC?
Technical Component (TC) is assigned when the physician does not own the equipment or facilities or employs the technician. In short, 26 modifier is assigned to pay for the physician services only. While TC modifier is assigned for the facilities used or the equipment used to perform the procedure.
What does LT mean in CPT coding?
leftIn some instances, procedure codes do not indicate on which side of the body a procedure is performed. In those instances, the modifier LT (left) or RT (right) is used to indicate the side of the body on which a service or procedure is performed.
Can you use two modifiers on one CPT code?
CPT modifiers are added to the end of a CPT code with a hyphen. In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second.
Can modifier RT and 59 be used together?
Don't add modifiers 59 or –X{EPSU} to either code to report 2 procedures for the same side of the body. If you performed 2 procedures on different sides of the body, you may report them with modifiers LT and RT as appropriate.
Where are articles related to LCD?
Articles are often related to an LCD, and the relationship can be seen in the “Associated Documents” section of the Article or the LCD.
What is a bill and coding article?
Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered.
What is CMS in healthcare?
The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare, Medicaid and the State Children's Health Insurance Programs, contracts with certain organizations to assist in the administration of the Medicare program. Medicare contractors are required to develop and disseminate Articles. CMS believes that the Internet is an effective method to share Articles that Medicare contractors develop. While every effort has been made to provide accurate and complete information, CMS does not guarantee that there are no errors in the information displayed on this web site. THE UNITED STATES GOVERNMENT AND ITS EMPLOYEES ARE NOT LIABLE FOR ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION, PRODUCT, OR PROCESSES DISCLOSED HEREIN. Neither the United States Government nor its employees represent that use of such information, product, or processes will not infringe on privately owned rights. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information, product, or process.
What is a local coverage article?
Local Coverage Articles are a type of educational document published by the Medicare Administrative Contractors (MACs). Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD).
Is CPT a year 2000?
CPT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon no upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
Can you use CPT in Medicare?
You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of CMS internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.
Why do contractors need to specify revenue codes?
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.
What modifier should be used for unilateral CPT?
Reporting these procedures with either an LT or RT modifier is appropriate if no unilateral CPT code exists. If a unilateral CPT code exists for the procedure, the unilateral CPT code should be reported with either the LT or RT modifier, with 1 unit of service. If no unilateral CPT code exists, modifier 52 should be appended to the bilateral CPT code to indicate a reduced service was performed.
What modifier should be used for anatomical codes?
These codes should be reported with the appropriate anatomical LT or RT modifier , with one unit of service for each. For example:
Why not use modifier 50?
CPT or HCPCS codes that are bilateral in intent or have bilateral in their description should not be reported with the bilateral modifier 50 or modifiers LT and RT because the code is inclusive of the bilateral procedure. CMS has updated its policies concerning the appropriate use and reporting of these modifiers.
When to report bilateral indicator 1?
Reporting these bilateral-indicator-1 procedures with either LT or RT and 1 unit of service is appropriate only if the procedure is being performed unilaterally. If the procedure is performed bilaterally, modifier 50 should be appended to the procedure code with 1 unit of service.
Can you use modifier 50 with a procedure code?
Do not use modifier 50 with a procedure code that is described as bilateral, or unilateral or bilateral, in its CPT description.
Do you submit modifier 50 on midline organs?
Do not submit modifier 50 on procedures for midline organs such as the bladder, uterus, esophagus and nasal septum.
Can a practitioner submit with modifier 50?
A practitioner can submit with modifier 50, if performed bilaterally.
What modifiers are used for Medicare?
Effective January 1, 2015, CMS will officially roll out four new HCPCS modifiers, XE, XP XS and XU , that can be used when billing Medicare claims. Dubbed the –X {EPSU} subset, they may or may not be used instead of modifier 59.
What is XP modifier?
Modifier XP Separate practitioner – A service that is distinct because it was performed by a different practitioner.
How does capture billing work?
Capture Billing helps medical practices by reducing their insurance accounts receivable and getting claims paid faster, allowing doctors to focus on providing quality healthcare to their patients without the stress of doing their own medical billing.
What is diagnostic procedure?
A diagnostic procedure is performed. Based on the findings, a therapeutic and/or surgical procedure is required on the same day. For example, diagnostic cardiac catheterization is followed by a medically necessary cardiac procedure.
Can you use modifier 59 with X?
Remember that you’ll never use modifier 59 in conjunction with one of the X {EPSU} modifiers. They are designed to be used separately – it’s either one or the other.
What are the most common modifiers in radiology billing?
The most common modifiers in radiology billing are 26, TC, 76, 77, 50, LT, RT, and 59. The following is a brief explanation regarding each modifier:
What is the modifier for a bilateral service?
In general, commercial plans will expect to see modifier 50 if a service is performed bilaterally and the procedure is not written as a bilateral service. If a service is performed on one side or the other, then the payer will expect to see modifier LT or RT. The payer will also expect to see modifier 52 if the service is written as a bilateral service (further explanation below).
What is incorrect modifier?
Incorrect modifier usage stands as the No. 2 reason for lost reimbursement in radiology practices, defined as either the wrong modifier being appended to a claim or no modifier being used when required. (The No. 1 reason is selecting the wrong code or incorrect documentation.)
What is modifier 59?
Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances.
When to use modifier 52?
Modifiers 52 and 53, which are utilized less frequently, are to be used when a service is started and not performed to its full extent for any reason. These modifiers yield a partial reimbursement.
Does modifier 50 reflect bilateral?
Keep in mind that some payers may not acknowledge modifier 50 to reflect bilateral sides. If this is the case, two line items will be reported: one with modifier LT and one with modifier RT. Modifier 50 is typically used more often than modifier LT/RT; however, payers generally dictate how these get used.
Do radiologists have to decrease their fees?
It is important to note that radiologists should not decrease the fees they submit to payers, as payers will do that themselves when a modifier 52 or 53 is submitted. However, fees should be increased when modifier 50 is submitted, with two units added when reporting on one line item because the payer will not automatically increase its reimbursement if the rates aren’t already increased.