Forum - Questions & Answers

Aug 20th, 2010 - marycpc

bilateral procedures

I'm having trouble getting a bilateral procedure paid with WellCare Insurance.
They refuse to tell me how they prefer to receive bilateral charges on the claim form. Does anyone know how Wellcare wants to receive these charges???

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Aug 20th, 2010 - jschmutz   323 

Bilateral Modifers for Wellcare

First, are you sure that the CPT® has a bilateral modifier of "1" or "3"?

Have you tried reporting a bilateral procedure as follows?

Line 1: 63030-50

Wellcare uses McKesson claims editing software.

-Identifies claim lines where the submitted procedure code has already been billed with a modifier -50 for the same date of service.

- Identifies procedure codes inappropriately billed with a bilateral modifier. Rule denies the charge, informing the provider that modifier 50 is not valid for the CPT® billed.

- Identifies claim lines with bilateral CPT® procedure code have been billed with a modifier 50 and a quantity greater than one. Rule denies the charge indicating that the bilateral procedure quantity has been billed incorrectly.

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Aug 24th, 2010 - Codapedia Editor 1,399 

bilateral

I agree with jschmutz: are you sure the procedure can be billed bilaterally?

If so, look at these two articles:

http://codapedia.com/-article_276_.cfm

http://codapedia.com/-article_199_.cfm

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