What modifier is used for CPT 69210?
What modifier is used for CPT 69210?
modifier -50
A: The coder would report CPT code 69210 (removal impacted cerumen requiring instrumentation, unilateral) with modifier -50 (bilateral procedure) twice.
What is the difference between CPT 69209 and 69210?
A new CPT code, 69209, provides a specific billing code for removal of impacted cerumen using irrigation/lavage. Like CPT 69210, (removal of impacted cerumen requiring instrumentation, unilateral) 69209 requires that a physician or qualified healthcare professional make the decision to irrigate/lavage.
Does CPT code 69210 need a modifier?
When you are using 69210 for ear wax impaction, it is appropriate to use an E/M code (with modifier -25) if the patient received a true evaluation and management for a separate problem (such as bronchitis or pharyngitis) or for complicating problems (such as dizziness or otitis media).
Can CPT code 69210 be billed with 50 modifier?
Additionally, the descriptor of 69210 has been clarified to reflect that the code is inherently unilateral. For bilateral impacted cerumen removal, report code 69210 with modifier 50, Bilateral Procedure, appended.
How do you bill CPT code 69210 Bilateral to Medicare?
Reporting 69210 Documentation should indicate the equipment used to provide the service. CPT® considers this procedure unilateral and states, “For bilateral procedure, report 69210 with modifier 50.” Contradictory to CPT®, Medicare considers this a bilateral procedure and prices it as such.
How Much Does Medicare pay for 69210?
| CPT Code 69210 Removal impacted cerumen (separate procedure), 1 or both ears | |
|---|---|
| Facility | |
| Average Medicare Reimbursement Per Procedure** | $33.88 |
| Break Even (Procedures) | 3.33 |
| TOTAL RETURN ON INVESTMENT | $727.50 |
How do I bill bilateral 69210 to Medicare?
Can 69210 and 69209 be billed together?
You may not bill CPT code 69209 with CPT code 69210, “removal impacted cerumen requiring instrumentation, unilateral,” for the same ear. However, CPT codes 69209 and 69210 can be billed for the same encounter if impacted cerumen is removed from one ear using instrumentation and from the other ear using lavage.
Is 69210 covered by Medicare?
Medicare cannot reimburse audiologists for CPT code 69210 or HCPCS code G0268 under any circumstances.
Do you need a modifier for 69210?
The doctor detects impacted cerumen and removes it, billing 69210. Although modifier -25 is not technically required because 69210 is not a starred procedure and not bundled with 99392 ( early childhood [age 1 through 4 years]), you should still use the modifier.
Is 69210 an unilateral or bilateral code?
Removal of cerumen that does not meet the criteria required under the new definition is considered to be included in the evaluation and management service rendered. procedure also defines procedure code 69210 as a “unilateral” procedure that should be reported using a -50 modifier (bilateral procedure) if performed on both ears.
Does Medicare cover 69210?
Medicare reimbursement for 69210 will only be made for one unit of service, regardless of whether one or two ears are involved. UCare will follow Medicare guidelines and will process claims for procedure code 69210 based on a unit of one. Claims submitted with a -50 modifier will deny.
Does Medicare cover 69210 CPT?
However, Medicare can pay audiologists only for medically necessary diagnostic testing, which is considered to include any incidental cerumen removal by the audiologist. Medicare cannot reimburse audiologists for CPT code 69210 or HCPCS code G0268 under any circumstances.
