KX Services qualifies for therapy capitation exception
LC Left circumflex coronary artery (Hospitals use with codes 92980– 92982, 92995, and 92996)
LD Left anterior descending coronary artery (Hospitals use with codes 92980–92982, 92995, and 92996)
LT Left side (used to identify procedures performed on the left side of the body)
Modifiers LT and RT Restrictions
Bilateral payment via the use of modifiers LT or RT is inappropriate for procedures, services, and supplies where the concept of laterality does not apply. Oxford will pay up to the maximum frequency per day value for codes with “bilateral” or “unilateral or bilateral” in description or for codes where the concept of laterality does not apply, whether submitted with or without modifiers LT and/or RT by the same individual physician, hospital, ambulatory surgical center, or other healthcare professional on the same date of service for the same member. Use of modifiers LT and/or RT on the codes identified in the “Codes Restricting Modifiers LT and RT” list will be considered informational only.
Codes Restricting Modifiers LT and RT
There may be situations where a physician, hospital, ambulatory surgical center, or other healthcare professional reports units accurately and those units exceed the established MFD value. In such cases, Oxford will consider additional reimbursement if reported with an appropriate modifier such as modifier 76, 59, 91, XE, XS or XU. Medical records are not required to be submitted with the claim when modifiers 59, 76, 91, XE, XS or XU are appropriately reported. Documentation within the medical record should reflect the number of units being reported and should support the use of the modifier.
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