On December 6, 2018, the DME MACs issued a joint publication notifying suppliers of a change in the way to bill for bilateral products dispensed on the same day. Previously, when two of the same items are given to patients for use on both limbs, the claim is billed with the RTLT modifier and 2 units of service.
Effective for claims with dates of service on or after March 1, 2019, suppliers must bill bilateral products on two separate claim lines. One line will have the HCPCS code with the RT modifier and the next claim line will have the same HCPCS code with the LT modifier. Each unit of service is one.
Bilateral items not billed on separate claim lines will be returned as unprocessable. Claims returned as unprocessable must be resubmitted. Unprocessable claims do not have appeal rights and cannot be reopened or submitted for adjustment.
Below is a list of the HCPCS requiring RT and LT modifiers and impacted by the updated Policy Articles:
Ankle-Foot/Knee-Ankle-Foot Orthoses (AFO/KAFO):
A4467, A9283, A9285, L1900, L1902, L1904, L1906, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980, L1990, L2000, L2005, L2010, L2020, L2030, L2034, L2035, L2036, L2037, L2038, L2106, L2108, L2112, L2114, L2116, L2126, L2128, L2132, L2134, L2136, L2180, L2182, L2184, L2186, L2188, L2190, L2192, L2200, L2210, L2220, L2230, L2232, L2240, L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, L2340, L2350, L2360, L2370, L2375, L2380, L2385, L2387, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2500, L2510, L2520, L2525, L2526, L2530, L2540, L2550, L2750, L2755, L2760, L2768, L2780, L2785, L2795, L2800, L2810, L2820, L2830, L2840, L2850, L2999, L4350, L4360, L4361, L4370, L4386, L4387, L4394, L4396, L4397, L4398, and L4631
External Breast Prostheses (EBP):
A4280, L8020, L8030, L8031, L8032, L8035, and L8039
Eye Prostheses:
L9900, V2623, V2624, V2625, V2626, V2627, V2628, and V2629
Facial Prostheses:
L8042, L8043, L8045, L8046, V2623, and V2629
Knee Orthosis (KO):
A4467, K0672, L1810, L1812, L1820, L1830, L1831, L1832, L1833, L1834, L1836, L1840, L1843, L1844, L1845, L1846, L1847, L1848, L1850, L1851, L1852, L1860, L2275, L2320, L2330, L2385, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2750, L2755, L2780, L2785, L2795, L2800, L2810, L2820, L2830, L2999, L4002, and L9900
Lower Limb Prostheses (LLP):
L5000, L5010, L5020, L5050, L5060, L5100, L5105, L5150, L5160, L5200, L5210, L5220, L5230, L5250, L5270, L5280, L5301, L5312, L5321, L5331, L5341, L5400, L5410, L5420, L5430, L5450, L5460, L5500, L5505, L5510, L5520, L5530, L5535, L5540, L5560, L5570, L5580, L5585, L5590, L5595, L5600, L5610, L5611, L5613, L5614, L5616, L5617, L5618, L5620, L5622, L5624, L5626, L5628, L5629, L5630, L5631, L5632, L5634, L5636, L5637, L5638, L5639, L5640, L5642, L5643, L5644, L5645, L5646, L5647, L5648, L5649, L5650, L5651, L5652, L5653, L5654, L5655, L5656, L5658, L5661, L5665, L5666, L5668, L5670, L5671, L5672, L5673, L5676, L5677, L5678, L5679, L5680, L5681, L5682, L5683, L5684, L5685, L5686, L5688, L5690, L5692, L5694, L5695, L5696, L5697, L5698, L5699, L5700, L5701, L5702, L5703, L5704, L5705, L5706, L5707, L5710, L5711, L5712, L5714, L5716, L5718, L5722, L5724, L5726, L5728, L5780, L5781, L5782, L5785, L5790, L5795, L5810, L5811, L5812, L5814, L5816, L5818, L5822, L5824, L5826, L5828, L5830, L5840, L5845, L5848, L5850, L5855, L5856, L5857, L5858, L5859, L5910, L5920, L5925, L5930, L5940, L5950, L5960, L5961, L5962, L5964, L5966, L5968, L5969, L5970, L5971, L5972, L5973, L5974, L5975, L5976, L5978, L5979, L5980, L5981, L5982, L5984, L5985, L5986, L5987, L5988, L5990, L5999, L7360, L7362, L7364, L7366, L7367, L7368, L7510, L7520, L7600, L7700, L8400, L8410, L8417, L8420, L8430, L8440, L8460, L8470, and L8480
Orthopedic Footwear:
A9283, L3000, L3001, L3002, L3003, L3010, L3020, L3030, L3031, L3040, L3050, L3060, L3070, L3080, L3090, L3100, L3140, L3150, L3160, L3170, L3201, L3202, L3203, L3204, L3206, L3207, L3208, L3209, L3211, L3215, L3216, L3217, L3219, L3221, L3222, L3224, L3225, L3230, L3250, L3251, L3252, L3253, L3254, L3255, L3257, L3260, L3265, L3300, L3310, L3320, L3330, L3332, L3334, L3340, L3350, L3360, L3370, L3380, L3390, L3400, L3410, L3420, L3430, L3440, L3450, L3455, L3460, L3465, L3470, L3480, L3485, L3500, L3510, L3520, L3530, L3540, L3550, L3560, L3570, L3580, L3590, L3595, L3600, L3610, L3620, L3630, L3640, and L3649
Refractive Lenses:
V2100, V2101, V2102, V2103, V2104, V2105, V2106, V2107, V2108, V2109, V2110, V2111, V2112, V2113, V2114, V2115, V2118, V2121, V2199, V2200, V2201, V2202, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2210, V2211, V2212, V2213, V2214, V2215, V2218, V2219, V2220, V2221, V2299, V2300, V2301, V2302, V2303, V2304, V2305, V2306, V2307, V2308, V2309, V2310, V2311, V2312, V2313, V2314, V2315, V2318, V2319, V2320, V2321, V2399, V2410, V2430, V2499, V2500, V2501, V2502, V2503, V2510, V2511, V2512, V2513, V2520, V2521, V2522, V2523, V2530, V2531, V2599, V2610, V2615, V2700, V2702, V2710, V2715, V2718, V2730, V2744, V2745, V2750, V2755, V2756, V2760, V2761, V2762, V2770, V2780, V2781, V2782, V2783, V2784, V2786, V2797, and V2799
Surgical Dressings:
A6531, A6532, and A6545
Therapeutic Shoes for Persons with Diabetes (TSD):
A5500, A5501, A5503, A5504, A5505, A5506, A5507, A5508, A5510, A5512, A5513, and K0903
Note: When same HCPCS code inserts are provided on the same date of service, bill the total number of units provided for the right side on a single claim line and the total number of units for the left side on a separate claim line.
Wheelchair Options/Accessories:
E0951, E0952, E0954, E0961, E0967, E0971, E0973, E0974, E0990, E0995, E1009, E1015, E1016, E1017, E1018, E1020, E2205, E2206, E2209, E2211, E2212, E2213, E2216, E2218, E2220, E2224, E2227, E2381, E2382, E2383, E2386, E2388, E2390, E2394, K0015, K0017, K0018, K0019, K0037, K0040, K0041, K0042, K0043, K0044, K0045, K0046, K0047, K0050, K0051, K0052, K0053, K0065, K0069, K0070, K0071, K0072, and K0077
Wheelchair Seating:
The Wheelchair Seating Policy Article was not updated with the articles addressed in the December 6, 2018 joint publication. Below is the listing of Wheelchair Seating HCPCS that require the RT and LT modifiers. When provided bilaterally on the same date of service, these items must also be billed on separate claim lines.
E0953, E0956, E1028 (RT/LT modifiers depending on the situation), and K0108 (RT/LT modifiers depending on the situation or item provided)