Showing posts with label RT AND LT modifiers. Show all posts
Showing posts with label RT AND LT modifiers. Show all posts

Monday, December 12, 2011

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.

Tuesday, June 21, 2011

Bilateral procedure code modifiers - RT, LT & 50 with example

Bilateral Procedures

Effective for dates of adjudication October 1, 2006 and thereafter the procedure for billing bilateral procedures changed. In the past, (through September 30, 2006), providers were instructed to bill for bilateral
procedures on one line with modifier 50. The reimbursement was adjusted to 150% of Medicaid’s fee schedule.

Effective for dates of adjudication October 1, 2006 and thereafter, the new procedure is as follows:

• Bill the appropriate procedure code on 2 separate lines with RT and LT modifier, or other appropriate anatomical modifier,

• Modifier 50 will be used for informational purposes only and is no longer a pricing modifier.

• The payment will be 100% of Medicaid fee schedule for first line and 50% for second line.

• Claims will be subject to multiple surgery payment adjustments for multiple procedures.

Example:
Line 1: 27558 RT
27558 LT; 50 (Optional use of modifier 50)

Alabama Medicaid utilizes Medicare’s RVU file to determine whether a 50 modifier, or RT and LT modifier should be allowed with the procedure code billed. When an inappropriate procedure code is billed with modifier 50, or RT and LT modifier, the claim will deny.


NOTE:

When Medicaid payment occurs for a procedure code billed inappropriately with modifier 50, AND/OR RT (right) AND/OR LT (left), the claim will be subject to a system adjustment in payment, post
payment review, and recoupment.

Most read cpt modifiers