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December 6, 2018

Correct Coding – RT and LT Modifier Usage Change

DME MAC Joint Publication

Several DME MAC LCD-related Policy Articles require the use of the RT and LT modifiers for certain HCPCS codes. The right (RT) and left (LT) modifiers must be used when billing two of same item or accessory on the same date of service and the items are being used bilaterally. Current instructions for billing products to be used bilaterally instruct suppliers to use the RTLT modifier on the same claim line and indicate two (2) units of service. This instruction is being changed in the Ankle-Foot/Knee-Ankle-Foot Orthoses (AFO/KAFO), External Breast Prostheses (EBP), 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.

Effective for claims with dates of service (DOS) on or after 3/1/2019, suppliers must bill each item on two separate claim lines using the RT and LT modifiers and 1 UOS on each claim line. Do not use the combination RTLT modifier on the same claim line and bill with 2 units of service (UOS). Claim lines for HCPCS codes requiring use of the RT and LT modifiers, billed without the RT and/or LT modifiers or with the RTLT on a single claim line, will be rejected as incorrect coding.

Refer to the Ankle-Foot/Knee-Ankle-Foot Orthoses (A52457External Website), External Breast Prostheses (A52478External Website), Eye Prostheses (A52462External Website), Facial Prostheses (A52463External Website), Knee Orthoses (A52465External Website), Lower Limb Prostheses (A52496External Website) , Orthopedic Footwear (A52481External Website) , Refractive Lenses (A52499External Website), Surgical Dressings (A54563External Website), Therapeutic Shoes for Persons with Diabetes (A52501), and Wheelchair Options/Accessories Policy Article (A52504External Website) and Standard Documentation Requirements Policy Article (A55426External Website) for additional coding and documentation requirements.

Publication History

December 6, 2018 Original Publication

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