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Nancy Posted 8 Year(s) ago

We have a patient that was given an administration of Cimzia in both left and right thigh. We billed the CPT code with 2 units but are only getting paid for one and the other unit is denying as inclusive. Should this have been billed 96401 x 1 unit and 96401 x 1 with modfier 76 or 96401 x1 unit modifier 76/59? Please advise. Thanks

SuperCoder Posted 8 Year(s) ago

The Transmittal öf CMS 785 in Example 2 regarding CPT 96401 says: ".....the beneficiary returns to the hospital and receives two injections of non-hormonal anti-neoplastic drugs. For the second encounter, the hospital reports one unit of 96401 with modifier 59, and one unit of 96401 without modifier 59."
This example is enough to say that in the given scenario we need to bill:

Posted by Nancy, 8 Year(s). There are 2 posts. The latest reply is from SuperCoder.

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