The Durable Medical Equipment Medicare Administrative Contractors (DME MAC) are changing the requirement that medical coders to use the right (RT) and left (LT) modifiers for certain HCPCS codes, and that the modifiers be used when billing two of the same item or accessory on the same date of service and the items are being used bilaterally.

The DME MACs currently instruct suppliers to use  modifier RTLT on the same claim line and indicate two units of service, but all that is changing  for Ankle-Foot/Knee-Ankle-Foot Orthoses (AFO/KAFO), External Breast Prosthesis  (EBP), Eye Prosthesis, Knee orthoses (KO), Lower LImb Prostheses (LLP), Orthopedic Footwear, Refractive Lenses, Surgical Dressing, Therapeutic Shoes for Persons with Diabetes (TSSD), and wheelchair options/accessories policy articles.

Use Two Lines

Since March 1, suppliers must bill each item on two separate claim lines using the RT and LT modifiers and 1 unit of service on each claim line.  Avoid using the combination on the same claim line and bill with 2 units of service. Claim lines for HCPCS codes requiring use of the RT and LT modifiers, billed without the RT or LT modifiers or with the RTLT on a single line simply will be rejected.