Resolved 76641 CPT Medicare

[CrystalB_3650]

Hello,
I have noticed that some insurances that follow medicare guidelines such as medicaid are still approving for two units for a breast ultrasound 76641. However, according to medicare July 1, 2022 the limit is one unit. Can someone please help explain what should be billed?
Thank you

 

[XiomaraR_77030]

On the CMS website it states: Medicare requires that when bilateral procedures are billed with one unit on one line with the CPT 50 modifier. The amount billed should reflect the cost of both the left and right sides.

 

[CrystalB_3650]

On the CMS website it states: Medicare requires that when bilateral procedures are billed with one unit on one line with the CPT 50 modifier. The amount billed should reflect the cost of both the left and right sides.

Thank you so much. I will definitely make note.

 

[Lori]

CPT code 76641 is unilateral.

Coding for Complete and Limited Ultrasound Breast Imaging

Code 76641 describes a complete examination of all four quadrants of the breast and the retroareolar region; 76642 describes a limited breast ultrasound.

www.aapc.com

BREAST SONOGRAPHY

If performed bilaterally, a modifier 50 may be reported with CPT code 76641 or 76642.

Article - Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography (A52849)

Use this page to view details for the Local Coverage Article for billing and coding: breast imaging: breast echography (sonography)/breast mri/ductography.

www.cms.gov

 

[CrystalB_3650]

Thank you so much. I will definitely make note.

Can you please provide the link for medicare or the documentation reference.
Thank you

 

[Lori]

Can you please provide the link for medicare or the documentation reference.
Thank you

They found that here:

Jurisdiction J Part B - Bilateral Procedures and Modifiers

www.palmettogba.com