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May 31, 2019 - Updated 07.02.19

Attention: RT and LT Modifier Usage and Unprocessable Claims – Bilateral Items Billed on Separate Claim Lines

Revised 06/25/2019 – HCPCS code K0903 was replaced with HCPCS code A5514 in Therapeutic Shoes for Persons with Diabetes (TSD) HCPCS section. All other information remains unchanged.

The DME MACs issued a "Correct Coding – RT and LT Modifier Usage Change" joint publication on December 6, 2018. The publication provided instructions for billing right (RT) and left (LT) modifiers on separate claim lines 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. The billing requirement is effective for DOS on or after 3/1/19. The instructions were 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.

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.

Below is a listing of HCPCS codes requiring RT and LT modifiers and impacted by the updated Policy Articles.

Ankle-Foot/Knee-Ankle-Foot Orthoses (AFO/KAFO):

A4467, A9283, A9285, L1900, L1902, L1904, L1906, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980, L1990, L2000, L2005, L2010, L2020, L2030, L2034, L2035, L2036, L2037, L2038, L2106, L2108, L2112, L2114, L2116, L2126, L2128, L2132, L2134, L2136, L2180, L2182, L2184, L2186, L2188, L2190, L2192, L2200, L2210, L2220, L2230, L2232, L2240, L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, L2340, L2350, L2360, L2370, L2375, L2380, L2385, L2387, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2500, L2510, L2520, L2525, L2526, L2530, L2540, L2550, L2750, L2755, L2760, L2768, L2780, L2785, L2795, L2800, L2810, L2820, L2830, L2840, L2850, L2999, L4350, L4360, L4361, L4370, L4386, L4387, L4394, L4396, L4397, L4398, and L4631

External Breast Prostheses (EBP):

A4280, L8020, L8030, L8031, L8032, L8035, and L8039

Eye Prostheses:

L9900, V2623, V2624, V2625, V2626, V2627, V2628, and V2629

Facial Prostheses:

L8042, L8043, L8045, L8046, V2623, and V2629

Knee Orthosis (KO):

A4467, K0672, L1810, L1812, L1820, L1830, L1831, L1832, L1833, L1834, L1836, L1840, L1843, L1844, L1845, L1846, L1847, L1848, L1850, L1851, L1852, L1860, L2275, L2320, L2330, L2385, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2750, L2755, L2780, L2785, L2795, L2800, L2810, L2820, L2830, L2999, L4002, and L9900

Lower Limb Prostheses (LLP):

L5000, L5010, L5020, L5050, L5060, L5100, L5105, L5150, L5160, L5200, L5210, L5220, L5230, L5250, L5270, L5280, L5301, L5312, L5321, L5331, L5341, L5400, L5410, L5420, L5430, L5450, L5460, L5500, L5505, L5510, L5520, L5530, L5535, L5540, L5560, L5570, L5580, L5585, L5590, L5595, L5600, L5610, L5611, L5613, L5614, L5616, L5617, L5618, L5620, L5622, L5624, L5626, L5628, L5629, L5630, L5631, L5632, L5634, L5636, L5637, L5638, L5639, L5640, L5642, L5643, L5644, L5645, L5646, L5647, L5648, L5649, L5650, L5651, L5652, L5653, L5654, L5655, L5656, L5658, L5661, L5665, L5666, L5668, L5670, L5671, L5672, L5673, L5676, L5677, L5678, L5679, L5680, L5681, L5682, L5683, L5684, L5685, L5686, L5688, L5690, L5692, L5694, L5695, L5696, L5697, L5698, L5699, L5700, L5701, L5702, L5703, L5704, L5705, L5706, L5707, L5710, L5711, L5712, L5714, L5716, L5718, L5722, L5724, L5726, L5728, L5780, L5781, L5782, L5785, L5790, L5795, L5810, L5811, L5812, L5814, L5816, L5818, L5822, L5824, L5826, L5828, L5830, L5840, L5845, L5848, L5850, L5855, L5856, L5857, L5858, L5859, L5910, L5920, L5925, L5930, L5940, L5950, L5960, L5961, L5962, L5964, L5966, L5968, L5969, L5970, L5971, L5972, L5973, L5974, L5975, L5976, L5978, L5979, L5980, L5981, L5982, L5984, L5985, L5986, L5987, L5988, L5990, L5999, L7360, L7362, L7364, L7366, L7367, L7368, L7510, L7520, L7600, L7700, L8400, L8410, L8417, L8420, L8430, L8440, L8460, L8470, and L8480

Orthopedic Footwear:

A9283, L3000, L3001, L3002, L3003, L3010, L3020, L3030, L3031, L3040, L3050, L3060, L3070, L3080, L3090, L3100, L3140, L3150, L3160, L3170, L3201, L3202, L3203, L3204, L3206, L3207, L3208, L3209, L3211, L3215, L3216, L3217, L3219, L3221, L3222, L3224, L3225, L3230, L3250, L3251, L3252, L3253, L3254, L3255, L3257, L3260, L3265, L3300, L3310, L3320, L3330, L3332, L3334, L3340, L3350, L3360, L3370, L3380, L3390, L3400, L3410, L3420, L3430, L3440, L3450, L3455, L3460, L3465, L3470, L3480, L3485, L3500, L3510, L3520, L3530, L3540, L3550, L3560, L3570, L3580, L3590, L3595, L3600, L3610, L3620, L3630, L3640, and L3649

Refractive Lenses:

V2100, V2101, V2102, V2103, V2104, V2105, V2106, V2107, V2108, V2109, V2110, V2111, V2112, V2113, V2114, V2115, V2118, V2121, V2199, V2200, V2201, V2202, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2210, V2211, V2212, V2213, V2214, V2215, V2218, V2219, V2220, V2221, V2299, V2300, V2301, V2302, V2303, V2304, V2305, V2306, V2307, V2308, V2309, V2310, V2311, V2312, V2313, V2314, V2315, V2318, V2319, V2320, V2321, V2399, V2410, V2430, V2499, V2500, V2501, V2502, V2503, V2510, V2511, V2512, V2513, V2520, V2521, V2522, V2523, V2530, V2531, V2599, V2610, V2615, V2700, V2702, V2710, V2715, V2718, V2730, V2744, V2745, V2750, V2755, V2756, V2760, V2761, V2762, V2770, V2780, V2781, V2782, V2783, V2784, V2786, V2797, and V2799

Surgical Dressings:

A6531, A6532, and A6545

Therapeutic Shoes for Persons with Diabetes (TSD):

A5500, A5501, A5503, A5504, A5505, A5506, A5507, A5508, A5510, A5512, A5513, and A5514

Note: When same HCPCS code inserts are provided on the same date of service, bill the total number of units provided for the right side on a single claim line and the total number of units for the left side on a separate claim line.

Wheelchair Options/Accessories:

E0951, E0952, E0954, E0961, E0967, E0971, E0973, E0974, E0990, E0995, E1009, E1015, E1016, E1017, E1018, E1020, E2205, E2206, E2209, E2211, E2212, E2213, E2216, E2218, E2220, E2224, E2227, E2381, E2382, E2383, E2386, E2388, E2390, E2394, K0015, K0017, K0018, K0019, K0037, K0040, K0041, K0042, K0043, K0044, K0045, K0046, K0047, K0050, K0051, K0052, K0053, K0065, K0069, K0070, K0071, K0072, and K0077

The Wheelchair Seating Policy Article was not updated with the articles addressed in the December 6, 2018 joint publication. Suppliers have recently inquired about which HCPCS in the Wheelchair Seating Policy Article require RT and LT modifiers. Below is the listing of Wheelchair Seating HCPCS that require the RT and LT modifiers. When provided bilaterally on the same date of service, these items must also be billed on separate claim lines.

Wheelchair Seating:

E0953, E0956, E1028 (RT/LT modifiers depending on the situation), and K0108 (RT/LT modifiers depending on the situation or item provided)

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