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92604

Janette Posted Mon 14th of September, 2015 16:53:53 PM

If our Audiologists bill 92604 with 92626 and 92627. For our follow up Cochlear Implant patients. Are we allowed to bill if they are testing both sides? Rt/Lt? do we bill with 50 modifier or Rt/Lt? I have been adding a 59 modifier to the 92626 code. Or are we even allowed to bill bilateral on the same day?

SuperCoder Answered Tue 15th of September, 2015 07:51:12 AM

CPT codes 92601-92604, when billing this code range, if bilateral analysis, fitting, and adjustments of bilateral cochlear implants, CMS recommends that a -22 modifier be added to the applicable code.

Reimbursement for binaural CI programming varies between payers. Please consult your payer(s) to determine if CI programming codes (92601-92604) are considered unilateral or single device codes.

Some payers may accept two line items of the same code with –RT or –LT ear modifiers to designate which side was programmed.

Other payers may consider a binaural programming session as a same-day repeat procedure. In this case, a separate bill with the same date of service would be completed. The second CI programming code would be billed with a repeat procedure modifier added (-76: Repeat procedure by same provider; or -77: Repeat procedure by another provider).

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