Avoid an Unprocessable Medicare Claim Denial

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On December 6, 2018, the DME MACs issued a joint publication notifying suppliers of a change in the way to bill for bilateral products dispensed on the same day. Previously, when two of the same items are given to patients for use on both limbs, the claim is billed with the RTLT modifier and 2 units of service.

Effective for claims with dates of service on or after March 1, 2019, suppliers must bill bilateral products on two separate claim lines. One line will have the HCPCS code with the RT modifier and the next claim line will have the same HCPCS code with the LT modifier. Each unit of service is one.

Bilateral items not billed on separate claim lines will be returned as unprocessable.  Claims returned as unprocessable must be resubmitted.  Unprocessable claims do not have appeal rights and cannot be reopened or submitted for adjustment. 

External Breast Prostheses are included. Read the full article from The van Halem Group.

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