tci Part B Insider - 2011 Issue 43

Reader Question: Modifier 50 Doesn't Always Apply

Question: When our physicians administer Botox for chronic migraines, we bill the HCPCS J code for the drug with procedure code 64613 and modifier 50. Payers are sending multiple denials, stating that the procedure/modifier combination is invalid. What's our best coding strategy? Answer: When billing injections of Botulinum toxins, aka chemodenervation, the key is to review the CPT® code terminology. The procedure code you'll turn to is 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]). Note that the descriptor states, "muscle(s)." Regardless of the number of injections your provider administers to the same...

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