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David McGill Blogger

Up. Down. Left. Right.

Posted by David McGill | December 11, 2012

While suppliers today may question some of the documentation requirements that RAC auditors focus on, few would argue that Medicare’s insistence on “left” or “right” modifiers for orthotic/prosthetic devices is unreasonable. However, Medicare’s guidance about the use of these directional modifiers when a supplier delivers them bilaterally on the same day of service has caused confusion in the past.

Last Friday, MAC Region B posted a “Billing Reminder” to its website, which includes the following guidance:

When bilateral items are provided on the same date of service, the supplier must append both the modifiers LT and RT on the same claim line and indicate two units of service. [emphasis added] Failure to append the required modifier(s) will result in a CO-16 denial due to lack of information required to completely adjudicate the claim.

This sounds basic. It is basic. Just don’t overlook the basics.

Note: this requirement applies to the following items: ankle foot orthoses; knee-ankle-foot orthoses; knee orthoses; lower limb prostheses; orthopedic footwear; and external breast prostheses, among others.

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