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BILATERAL PROCEDURES

SuperCoder Posted Wed 20th of February, 2013 21:27:12 PM

please tell me how to bill for bilateral MRIs (73720-26) of the knee and get paid for both. Is it possible?

SuperCoder Answered Wed 20th of February, 2013 21:51:53 PM

For payers following Medicare rules, you should get paid for each side. Note that some payers request the use of 2 line items with mod RT on one and mod LT on the other, while others say to append modifier 50 to 73720-26, so check payer policy.

The CMS fee schedule gives 73720-26 a bilateral indicator of 3, which means, “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.”

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