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August 2, 2019

Diabetic Shoe and RT LT Modifiers: Your Claims Could be Denied

The DME MACs issued a "Correct Coding – RT and LT Modifier Usage Change" joint publication on December 6, 2018, which provided instructions for billing right (RT) and left (LT) modifiers on separate claim lines. This is applicable when two of the same items or accessories (same HCPCS codes) are provided on the same date of service (DOS) and the items are being used bilaterally and was effective for DOS on or after 3/1/19. These instructions have now been changed in several Policy Articles.

Bilateral items not billed on separate claim lines will be returned as unprocessable. Diabetic Shoe modifiers should also be billed on separate lines to avoid this. Unprocessable claims must be resubmitted and do not have appeal rights or the ability to be reopened or adjusted.

In July, 13% of JC claims that included RT and LT modifers would have rejected with the outdated instructions, so be sure to review them and your applicable claims!

Click here for the full list of HCPCS codes requiring RT and LT modifiers and impacted by the updated Policy Articles.

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