Are You Still Billing RT and LT Modifiers on the Same Line?

A recent CMS instruction alters how suppliers bill for bilateral items. Effective March 1, 2019, RT and LT modifiers can no longer be used on the same claim line.

For years, the MACs instructed suppliers to bill two items on one single line with both the RT and LT modifiers. After March 1st, the MACs will reject these claims for incorrect coding. Going forward, suppliers must bill each unit separately.

​The following policies are affected by the change:
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• Ankle-Foot/Knee-Ankle-Foot Orthoses (AFO/KAFO),
• External Breast Prostheses,
• Eye Prostheses,
• Facial Prostheses,
• Knee Orthosis (KO),
• Lower Limb Prostheses (LLP),
• Orthopedic Footwear,
• Refractive Lenses,
• Surgical Dressings,
• Therapeutic Shoes for Persons with Diabetes (TSD), and
• Wheelchair Options/Accessories Policy Articles.

Billing Software Considerations

Suppliers often use fee schedule prompts inside their billing software to generate clean claims. For example, suppliers often have three common pricing prompts configured:

• Right side only.
• Left side only.
• Bilateral for both sides.

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Each option engages the correct modifier for the selection (RT, LT and RTLT).

To comply with the new CMS directive, MiraVista recommends suppliers expire the third option for bilateral combinations after February 28, 2019.

Admittedly, suppliers with numerous accessories and products attached to bilateral options will find the task particularly tedious. In fact, most billing systems will not allow suppliers to split a claim line after it is created. In those cases, suppliers must write off the original line item and create a new order.

For suppliers using Brightree billing software, the vendor will expire the bilateral pricing option automatically.

Be sure to educate your staff. Preparation will prevent rejected claims and laborious rework to fix claims. 

SOURCE LINKS
https://www.cgsmedicare.com/jc/pubs/news/2018/1218/cope10157.html