tci Part B Insider - 2014 Issue 5

Part B Payment: Bilateral Cerumen Removals Could Prompt Denials

Medicare decides not to pay for two cerumen removals in the same visit. When  CPT® clarified the language in  CPT® 2014 regarding cerumen removal, it seemed like good news. But thanks to a CMS rule, that news could be turning sour. Background:  CPT® 2014 changed the descriptor for 69210 to “Removal of impacted cerumen requiring instrumentation, unilateral.” Therefore, most practices understood that they’d need to append a bilateral modifier (modifier 50) to 69210 when removing cerumen from both ears. Why? Although the descriptor for this code used to say “one or both ears,&rdquo...

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