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Ask a Rev Cycle Expert: CPT 64494 Bilateral Reporting?

Question:

Current Procedural Terminology (CPT®) code 64494 INJ PARAVERT F JNT L/S 2 LEV is being performed bilaterally at our office. CPT® Guidelines say to report bilateral procedures twice, but there is a Medically Unlikely Edit (MUE) of 1. What is the correct way to report the bilateral procedure?

Answer:

This is one of those frustrating instances where CPT® guidance and the Centers for Medicare & Medicaid Services (CMS) guidance differs. CMS states claims should be submitted following guidance for modifier 50 Bilateral Procedure, i.e., report code 64494 with modifier 50 and one unit of service. You should follow the payer’s guidance for reporting bilateral procedures, as guidance may differ.

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