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95885 with new emg/ncv testing

Pamela Posted Fri 11th of January, 2013 16:14:47 PM

We used to bill 95903 and 95904 bilaterally, with 50 on each. We also put a 50 on the 95885. Since the 95903,95904 and 95934 are all now bundled shouldn't the 95885 just be billed with 2 units and not with 50 modifier since the new code 95911 isn't billed bilat.

Thanks.

SuperCoder Answered Wed 16th of January, 2013 12:00:23 PM

95903, 95904 and 95934 are all deleted codes in 2013. Earlier in 2012, when all 5 codes were valid, there was no bundling between them, so all codes could be reported individually w/o any modifier. But in 2013, only 95885 and 95911 are valid. And there is no bundling b/w these two.

95885 ->150% bilateral payment adjustment doesn't apply. Each side paid separately. For bilateral service (e.g., 50, RT/LT, 2 units) payment for each side is lower of (a) actual charge for each side or (b) fee schedule amount for each side. So yes, bill 2 units separately.

95911 -> 150% bilateral payment adjustment doesn't apply. So no modifier 50 applicable.

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