This was bugging me so I dug a little deeper...
Can the codes be billed bilaterally?
Chemodenervation codes 64612, 64613, and 64614 are identified in the MPFS database as codes for which the allowance for procedures performed bilaterally will be 150% of allowance for the unilateral service. Bilateral procedures may be reported on a single line using modifier -50 and reporting 1 unit of service. Alternatively, bilateral procedures may be reported on 2 lines using the RT and LT modifiers and reporting 1 unit of service for each. Please note, under the MPFS, Medicare payment is set as the lesser of the fee schedule allowance or the actual charge.
Anecdotally, there are a variety of differing policies from other payers. Therefore, we now inform our members that there is variability in the policies different insurance carriers and health plans have regarding these codes. The individual provider will need to determine what is the proper billing procedure for these codes in his or her locality for the specific payer to whom a claim is submitted.
One Medicare carrier has an exception to the rule...
CPT codes 64612-64614 should be reported only one (1) time per procedure, even if multiple injections are performed in sites along a single muscle or if several muscles in a functional muscle group are injected.
However, in the case of treating bilateral blepharospasm, procedure code 64612 may be billed once for each eye with the appropriate modifier. In this case procedure code 64612 is allowed at 150% when performed bilaterally
So this will become carrier discretion. I would check with your carriers and get their policy in writing...
Last edited by RebeccaWoodward*; 12-09-2009 at 09:04 AM.
Pain Management Code Changes
I’ll bet you thought I was going to say the more things change, the more they stay the same – but this isn’t the case with chemodenervation procedures described by CPT codes 64612-64614.
There were some subtle changes to these codes in 2013 and there will be more drastic changes coming in 2014. First let’s look at the coding guidelines that should be used until the end of this year before the coding changes go into effect.
The text for CPT code 64612 was revised in 2013 and “unilateral” was added to this code description along with parenthetical notes that allow for reporting with modifier -50 (bilateral procedure). The other two codes 64613 and 64614 also had revised parenthetical notes added clarifying that these services CANNOT be reported as bilateral procedures and that the CPT code should only be reported “once per session”.
NOTE: CMS guidelines differ and codes 64612-64614 have a payment indicator of “1” for modifier -50 indicating that a 150% payment adjustment is made for bilateral procedures meaning that all three codes (64612-64614) can be reported as bilateral services for Medicare beneficiaries
Now in 2014, CPT code 64612 will remain the same but codes 64613 and 64614 have been deleted with 64613 being replaced with new codes 64616/64617 and 64614 being replaced with new codes 64642-64647.
Here’s an explanation of the code changes;
Code description for 64613 was for chemodenervation of the neck muscles. This code was deleted and broken out into two new codes 64616 (neck muscle(s), excluding muscles of the larynx, unilateral) with parenthetical notes indicating that this procedure may be reported bilaterally with modifier -50, and when performed, codes 95873 or 95874 for chemodenervation guided by needle EMG or muscle electrical stimulation may be additionally reported. Code 64617 is for chemodenervation of muscles of the larynx. This also is a unilateral procedure, so bilateral reporting is acceptable but the code description includes guidance by needle EMG so 95873/95874 cannot be additionally reported.
Code description for 64614 was for chemodenervation of extremity and/or trunk muscles. This code was deleted and broken out into six new codes.
64642 – Chemodenervation of one extremity, 1-4 muscle(s)
+64643 – each additional extremity, 1-4 muscle(s)
64644 – Chemodenervation of one extremity, 5 or more muscles
+64645 – each additional extremity, 5 or more muscle(s)
64646 – Chemodenervation of trunk muscle(s), 1-5 muscle(s)
+64647 – 6 or more muscles
Modifier -50 is not reported with any of the new CPT codes from code range 64642-64647 but needle guided EMG or muscle electrical stimulation can additionally be reported with codes 95873 or 95874.