RT and LT Modifier Usage Change (effective 2019-03-01)

May 21st, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Categories:   Dermatology|Plastic Surgery   Orthopedics   Physical Medicine|Physical Therapy   Podiatry  
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According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s). In the past, it was appropriate to bill the RT and LT modifier on the same line when it was required for certain HCPCS codes. Noridian released a publication stating claims reported with RT/LT on the same line will be denied when reporting certain HCPCS codes.

Changes apply to HCPCS codes for 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.

"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."

For additional information refer to the following articles from Noridian, Ankle-Foot/Knee-Ankle-Foot Orthoses (A52457 ), External Breast Prostheses (A52478 ), Eye Prostheses (A52462 ), Facial Prostheses (A52463 ), Knee Orthoses (A52465 ), Lower Limb Prostheses (A52496 ), Orthopedic Footwear (A52481 ) , Refractive Lenses (A52499 ), Surgical Dressings (A54563 ), Therapeutic Shoes for Persons with Diabetes (A52501 ), and Wheelchair Options/Accessories Policy Article (A52504 ) and Standard Documentation Requirements Policy Article (A55426 ) for additional coding and documentation requirements.

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