tci Part B Insider - 2015 Issue 20

Reader Question: Modifier 50 May Not Apply to All Bilateral Claims

Question: Our specialist administered several facet joint injections and appended modifier 50 to represent multiple levels, but we only got paid for one level. What did we do wrong? Answer:  If the injections occur on the same side of the spine, you won’t append modifier 50, according to results that recovery audit contractors (RACs) recently provided to CMS, which were published in its Jan. 2015 Medicare Quarterly Provider Compliance Newsletter. The publication focused in on facet joint injections as one procedure that is billed so infrequently that it’s a common source of overpayments. “An overpayment...

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