CGS, the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) for Jurisdictions B and C has issued a reminder regarding billing right (RT) and left (LT) modifiers on separate claim lines. There are 6 device categories related to lower extremity care: ankle-foot/knee-ankle-foot orthoses, knee orthoses, lower limb prostheses, orthopedic footwear, surgical dressings, and therapeutic shoes for persons with diabetes.
The DME MACs issued a joint publication on December 6, 2018, which provided instructions for the usage of RT and LT modifiers. The instructions apply when 2 of the same items or accessories with the same Healthcare Common Procedure Coding System (HCPCS) codes are provided on the same date of service and the items are being used bilaterally. This change took effect for claims with dates of service on or after March 1, 2019. Claims not submitted in this manner will be returned as unprocessable, and then will have to be resubmitted. Unprocessable claims do not have appeal rights and cannot be reopened or adjusted.
CGS stated that in July, 17% of Jurisdiction B claims and 13% of Jurisdiction C claims would have been rejected with the outdated instructions, and is reminding practitioners to review these instructions and their claims prior to submission.
To read the joint publication, Correct Coding –RT and LT Modifier Usage Change, go to cgsmedicare.com/jc/pubs/news/2018/1218/cope10157.html. To access the full list of affected HCPCS codes, visit cgsmedicare.com/jc/pubs/news/2019/05/cope12669.html.
