Medicare Billing bilaterals
Randy McFarland
Description
Collection
Title:
Medicare Billing bilaterals
Creator:
Randy McFarland
Date:
6/21/2013
Text:
ORIGINAL POST
Hi Listserve members,
Most pay sources want us to list left and right on separate lines.
I understand that Medicare said we can invoice diabetic shoes on a single
line indicating L and R. Can anyone tell me if Medicare will also accept a
billing if we use separate lines for each side on a bilateral delivery?
Thanks, Randy McFarland, CPO Fullerton, CA
RESPONSES
I believe you would need to bill on one line. I would suggest checking the
LCD/Policy for the item you are wanting to bill and see if it states
anything about using RT and LT on different lines when billing the same
HCPCS code.
Read it for yourself! Why would you listen to the list serve when your
financial responsibility is at question? Totally baffles the mind....
Assuming you are speaking of bilateral orthoses or prostheses, if you want
it to pay for both, list them separately. (Some of the reviewers don't
understand the definition of bilateral so you have to help them out.) This
also enables you to customize your work pursuant to their clinical
presentation, or repairs, add-ons, etc. Don't forget the code modifier to
show you have the medical chart notes/documentation to support your
billed-for services.
Shoes can go on a single line because they typically (usual & customary) are
provided in pairs. However, if you put LTRT on the single line make sure
you put 2 in the number of units or you get gypped out of part of your
reimbursement. Have a Super Day!
I have always billed both on 1 line with no problem as follows
DOS A5500 LT RT KX DX CODE $AMOUNT 2
Yes - Medicare allows one line for bilateral - remember, with diabetic shoes
and inserts to use the KX modifier as well, indicating that you have all of
the required documentation on file.
Great question! I own and operate a medical billing business and we do
quite a bit of O&P billing all over the US. Drop me a line anytime if you
have a question.
To be completely honest with you...I have counseled my clients away from
doing a bilateral delivery to ANY insurance on the same day. With the
number of appointments necessary to make sure fit and function are good, I
have suggested focusing on one prosthetic at a certain visit. Deliver both
to use, but consider one side a test fitting and the other the side the
final delivery. Bring the patient back in a few days/weeks and check fit
and function on the test fitted side (and check the final delivered side as
well to make sure all is well). If everything is great, get the final
delivery slip signed at that point for the other side. Chart your focus on
each side independently and it helps show care and concern about patient
well being.
No matter how clean paperwork is, delivering 2 prosthetics on the same day,
insurance companies jump on and either pend or deny several items if not a
whole side (even with preauth for commercial insurances).
Just my 2 cents from billing a large amount of bilateral prosthetics over
the years and seeing current trends.
Hi Listserve members,
Most pay sources want us to list left and right on separate lines.
I understand that Medicare said we can invoice diabetic shoes on a single
line indicating L and R. Can anyone tell me if Medicare will also accept a
billing if we use separate lines for each side on a bilateral delivery?
Thanks, Randy McFarland, CPO Fullerton, CA
RESPONSES
I believe you would need to bill on one line. I would suggest checking the
LCD/Policy for the item you are wanting to bill and see if it states
anything about using RT and LT on different lines when billing the same
HCPCS code.
Read it for yourself! Why would you listen to the list serve when your
financial responsibility is at question? Totally baffles the mind....
Assuming you are speaking of bilateral orthoses or prostheses, if you want
it to pay for both, list them separately. (Some of the reviewers don't
understand the definition of bilateral so you have to help them out.) This
also enables you to customize your work pursuant to their clinical
presentation, or repairs, add-ons, etc. Don't forget the code modifier to
show you have the medical chart notes/documentation to support your
billed-for services.
Shoes can go on a single line because they typically (usual & customary) are
provided in pairs. However, if you put LTRT on the single line make sure
you put 2 in the number of units or you get gypped out of part of your
reimbursement. Have a Super Day!
I have always billed both on 1 line with no problem as follows
DOS A5500 LT RT KX DX CODE $AMOUNT 2
Yes - Medicare allows one line for bilateral - remember, with diabetic shoes
and inserts to use the KX modifier as well, indicating that you have all of
the required documentation on file.
Great question! I own and operate a medical billing business and we do
quite a bit of O&P billing all over the US. Drop me a line anytime if you
have a question.
To be completely honest with you...I have counseled my clients away from
doing a bilateral delivery to ANY insurance on the same day. With the
number of appointments necessary to make sure fit and function are good, I
have suggested focusing on one prosthetic at a certain visit. Deliver both
to use, but consider one side a test fitting and the other the side the
final delivery. Bring the patient back in a few days/weeks and check fit
and function on the test fitted side (and check the final delivered side as
well to make sure all is well). If everything is great, get the final
delivery slip signed at that point for the other side. Chart your focus on
each side independently and it helps show care and concern about patient
well being.
No matter how clean paperwork is, delivering 2 prosthetics on the same day,
insurance companies jump on and either pend or deny several items if not a
whole side (even with preauth for commercial insurances).
Just my 2 cents from billing a large amount of bilateral prosthetics over
the years and seeing current trends.
Citation
Randy McFarland, “Medicare Billing bilaterals,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/235276.
