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botox bilateral billing

Rana Posted Wed 10th of July, 2019 14:06:04 PM
when billing for bilateral botox injections how do we bill to get the maximum allowed payment? using mod 50 does not seem to make a difference. should i bill for example ...................92012 57 with 64612 LT, 64612 RT, 64616 LT, 64616 RT, 64646 LT, 64646 RT....OR should i just use 50 modifier and double our original billed amount per code line to pay more. we bill 350.00 now for each line code?
SuperCoder Answered Thu 11th of July, 2019 06:57:11 AM

Hi Rana,


Modifiers should be appended as per the correct coding guidelines. If all the three procedures were performed bilaterally, you should use modifier 50 with CPT codes 64612 and 64616 on single line item. You should append modifier LT and RT with CPT code 64646 on single line item. 


Rationale: Per MPFS Q3, 2019, Modifier 50 is invalid modifier for CPT code 64646 and hence should not be appended with this code. Instead use RT or LT modifier with CPT code 64646 on a single line item. Modifier 50 is valid modifier for CPT codes 64612 and 64616 and should be used for bilateral procedure.


Hope provided information would be helpful.



Rana Posted Thu 11th of July, 2019 10:06:54 AM
can we double the billed amount since it is bilateral and use 50 mod on the appropriate lines and get 150% of allowed amount for bilateral surgery
SuperCoder Answered Fri 12th of July, 2019 03:49:20 AM

Hi Rana,


Yes, that would be the correct way to bill for CPT codes 64612 and 64616. Adding modifier 50 would ensure you get 150% of the amount (out of the doubled amount) for these codes. Do not use 50 modifier for CPT code 64646 for the reason mentioned in earlier post. Use LT and RT modifier instead for this code on a single line and double the amount here as well.


Hope it helps!  

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