Forum - Questions & Answers

May 26th, 2011 - vazquezy 2 

HCPCS code G0364

I am trying to figure out if it would be appropriate to bill G0364 with modifier 50 when done bilaterally or bill on two lines with RT and LT. Could you provide some guidelines?

Thank you,
Yvonne

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May 26th, 2011 - jschmutz   323 

re: HCPCS code G0364

A bilateral modifier is inappropriate for this code (a) because of physiology or anatomy, or (b) because the code description specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure.

. If procedure is reported with modifier -50 or with modifiers RT and LT, the payment will be based on the payment for the two sides on the lower of: (a) the total actual charge for both sides or (b) 100% of the fee schedule amount for a single code.

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Jun 1st, 2011 - vazquezy 2 

re: HCPCS code G0364

The code is inherently unilateral and there is no bilateral code. The aspirations and biopsies are of the right posterior iliac crest and the left posterior iliac crest. Therefore, would modifiers 50 or RT/LT be most appropriate?

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Jun 1st, 2011 - jschmutz   323 

re: HCPCS code G0364

G0364 is for a bone marrow aspiration when performed with a bone marrow biopsy through the same incision. This is a Medicare code and Medicare states that it won't be paid as a bilateral procedure. If it is being done at two separate sites then report G0364 and G0364-59

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Jun 2nd, 2011 - vazquezy 2 

re: HCPCS code G0364

Thanks, we'll try that.

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