CGS Update: Diabetic Shoe and RT LT Modifier Billing Changes

Home Blog CGS Update: Diabetic Shoe and RT LT Modifier Billing Changes

Recently, CGS sent out an email in regards to the DME MACs “Correct Coding - RT and LT Modifier Usage Change” joint publication from December 6, 2018. This publication 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.  

Effective October 15th, according to CGS, bilateral items not billed on separate claim lines will be returned as unprocessable. This means that any claims returned as unprocessable must be resubmitted. Unprocessable claims do not have appeal rights and cannot be reopened or submitted for adjustment. 

A link to the full list of HCPCS codes requiring RT and LT modifiers and impacted by the updated Policy Articles can be found here. Click here to read the original publication

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