Medicaid Jcode and RT & LT modifiers

by | Dec 13, 2011 | CPT 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.