Medicaid Jcode and RT & LT modifiers

RT and LT Modifier Requirements for Intravitreal (Eye)
and Intra-Articular (Knee) Injections

Effective January 1, 2012, Florida Medicaid will require either RT or LT modifiers on HCPCS drug codes related to intravitreal (eye) and intra-articular (knee) injections. The reference chart of HCPCS codes listed below will require RT or LT modifiers.  Additionally, the following modifiers may no longer be used:  22, 50, and/or 99.  Using modifiers 22, 50, and/or 99 will cause the claim to reject.

Each submitted claim must reflect the anatomical site, right (RT) or left (LT), where the injection was administered. This modifier requirement is applicable when a patient receives a unilateral injection (one side), or bilateral injections (both sides) during a single visit. Bilateral injections on a single visit are to be billed in two (2) separate claims using RT and LT 
modifiers.

Procedure Code	Drug name
C9257	INJECTION, BEVACIZUMAB, 0.25 MG (ATVASIN)
J2503	INJECTION, PEGAPTANIB SODIUM, 0.3 MG (MACUGEN)
J2778	INJECTION, RANIBIZUMAB, 0.1 MG (LUCENTIS)
J7310	GANCICLOVIR, 4.5 MG, LONG-ACTING IMPLANT  (VITRASERT)
J7311	FLUOCINOLONE ACETONIDE, INTRAVITREAL IMPLANT (RETISERT)
J7312	INJECTION, DEXAMETHASONE, INTRAVITREAL IMPLANT, 0.1 MG (OZURDEX)
J7321	HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTICULAR INJECTION, PER DOSE
J7323	HYALURONAN OR DERIVATIVE, EUFLEXXA, FOR INTRA-ARTICULAR INJECTION, PER DOSE
J7324	HYALURONAN OR DERIVATIVE, ORTHOVISC, FOR INTRA-ARTICULAR INJECTION, PER DOSE
J7325	HYALURONAN OR DERIVATIVE, SYNVISC OR SYNVISC-ONE, FOR INTRA-ARTICULAR, INJECTION, 1MG
J7326	HYALURONAN OR DERIVATIVE, GEL-ONE, FOR INTRA-ARTICULAR INJECTION, PER DOSE**

**RT/LT modifier will be required when J7326 is activated in the Medicaid system.