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bilateral intravitreal injections

Lori Posted Tue 24th of August, 2010 11:12:25 AM

67028 CMS puts 50 modifier on our avastin injection and pays less
for the second eye. We are filing individual eyes with rt, lt mod. Any sugggestions?

SuperCoder Answered Wed 25th of August, 2010 04:56:01 AM

150% payment adjustment for bilateral procedures applies. If the code is billed with the bilateral modifier or is reported twice on the same day by any other means (e.g., with RT and LT modifiers, or with a 2 in the units field), base the payment for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides or (b) 150% of the fee schedule amount for a single code. If the code is reported as a bilateral procedure and is reported with other procedure codes on the same day, apply the bilateral adjustment before applying any multiple procedure rules.
Also, note that the usual frequency of intravitreal injection is once every six weeks, per eye. Services provided in excess of this frequency will be denied.

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