The Durable Medical Equipment Medicare Administrative Contractors (DME MAC) are changing the requirement that medical coders to use the RT and LT modifier for certain HCPCS codes, and that the modifiers be used when billing two of the same item or accessory on the same date of service and the items are being used bilaterally.
Until now, suppliers billing for bilateral DME devices including therapeutic shoes for patients with diabetes, diabetic inserts, custom AFOs or custom foot orthoses, have been able to submit electronic claims by indicating the total quantity and using the RTLT modifier on a single line OR by using RT on one line and LT on another, noting half the quantity on each.
Several DME MAC LCD-related Policy Articles require the use of the RT and LT modifiers for certain HCPCS codes. The right (RT) and left (LT) modifiers must be used when billing two of the same item or accessory on the same date of service and the items are being used bilaterally. Current instructions for billing products to be used bilaterally instruct suppliers to use the RTLT modifier on the same claim line and indicate two (2) units of service.
This instruction is being changed in the Ankle-Foot/Knee-Ankle-Foot Orthoses (AFO/KAFO), External Breast Prostheses (EBP), Eye Prostheses, Facial Prostheses, Knee Orthoses (KO), Lower Limb Prostheses (LLP), Orthopedic Footwear, Refractive Lenses, Surgical Dressings, Therapeutic Shoes for Persons with Diabetes (TSD), and Wheelchair Options/Accessories Policy Articles.
Effective for claims with dates of service (DOS) on or after 3/1/2019, suppliers must bill each item on two separate claim lines using the RT and LT modifiers and 1 UOS on each claim line. Do not use the combination RTLT modifier on the same claim line and bill with 2 units of service (UOS). Claim lines for HCPCS codes requiring the use of the RT and LT modifiers billed without the RT and/or LT modifiers or with the RTLT on a single claim line, will be rejected as incorrect coding.
As always, each claim line should also include the modifier XK to indicate that all required compliance documentation is on file. When billing L3000 for custom foot orthotic devices, the GY modifier should be used to indicate that the item is statutorily excluded and cause the claim to deny.
FAQs:
1. What are the new requirements for using RT and LT modifiers?
Effective 3/1/2019, suppliers must bill each bilateral item on separate claim lines using RT and LT modifiers, rather than using the RTLT modifier on a single line.
2. What items are affected by this change?
This requirement applies to various items, including therapeutic shoes, custom orthoses, and knee/ankle-foot orthoses, among others.
3. How should I submit claims for bilateral items?
You should submit each bilateral item on two separate lines: one line with the RT modifier and one line with the LT modifier, each with one unit of service.
4. What happens if I don’t follow the new modifier guidelines?
Claims submitted without the correct RT or LT modifiers, or with the RTLT modifier on a single line, will be rejected due to incorrect coding.
5. What additional modifier should be included on the claim line?
Each claim line should include the XK modifier to indicate that all required compliance documentation is on file for the billed items.
