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Hi Guest! Very likely yes! So, for the bone graft codes 21210 & 21215, if bone was not harvested from the patient, you”ll want to use modifier 52 for reduced services. Also for 21210 & 21215, if they were performed on the same date of service, you”ll want to add modifier 51 on the lower priced of the two, to indicate multiple surgeries/procedure on the same date of service. Also, if 99203 is billed on the same date as the 21210 & 21215, you”ll want to add modifier 25 to indicate it is a separately identifiable E&M service performed on the same date as the procedure(s). Hope this helps!
Hi Guest! There some some medical insurers who require that providers enroll as an out-of-network provider in order to process claims (I.e. Tricare, certain BCBS”s, etc). Some medical insurers will simply ask the provider to submit a copy of their W-9 when the first claim is sent. Hope this helps!
Do you need the dental provider to bill the CPT code 21210 to be credentialed in medical insurance to get paid? Please advise, thank you.
Hi Guest! Great question. We have actually seen different medical insurers process these differently! As you mentioned, some medical insurers prefer the units to be correlated with the quadrants (i.e. 2 units of 21210 for UR and UL quadrants), while we have seen some prefer it to be billed as 1 unit. We recommend using the JO qualifiers to indicate the quadrants on the line item. Hope this helps! What about Medicare? I have found they deny mutually inclusive if you bill 2 units. I have also heard others tell scary stories about audits involved with billing 2 units of bone grafting and not only 1. My doctor is concerned that he will get in trouble for billing 2 units.
Hi Guest! Great question. We have actually seen different medical insurers process these differently! As you mentioned, some medical insurers prefer the units to be correlated with the quadrants (i.e. 2 units of 21210 for UR and UL quadrants), while we have seen some prefer it to be billed as 1 unit. We recommend using the JO qualifiers to indicate the quadrants on the line item. Hope this helps!
This has always been controversial – is bone grafting billed per arch or per quadrant? Can you bill 2 units of 21210 or 2 units of 21215 on the same day if performed in 2 quadrants in the same jaw?
Does 99203, 21210 and 21215 need any modifier? If yes, I have auth for these cpt codes but do not know if I should call insurance company back and update adding the modifier.
Hi Guest! Since the gone graft codes specify mandibular & maxillary, there is no need to use the 50 modifier (which stands for Bilateral Procedures). Modifier 51 stands for multiple surgeries/procedures. Bone grafting codes: 21210 – Graft, bone; nasal, maxillary or malar areas (includes obtaining graft) 21215 – Graft, bone; mandible (includes obtaining graft) **use modifier -52 for reduced services when bone is not obtained from patient Hope this helps!
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