Does Medicare cover 69210?
The bottom line is that Medicare will pay you the same amount for 69210 whether you do one ear or two, even though the CPT descriptor now says it is for one ear only.
How Much Does Medicare pay for 69210?
| CPT Code 69210 Removal impacted cerumen (separate procedure), 1 or both ears | |
|---|---|
| Facility | |
| Average Medicare Reimbursement Per Procedure** | $33.88 |
| Break Even (Procedures) | 3.33 |
| TOTAL RETURN ON INVESTMENT | $727.50 |
How do I bill bilateral 69210 to Medicare?
A: The coder would report CPT code 69210 (removal impacted cerumen requiring instrumentation, unilateral) with modifier -50 (bilateral procedure) twice. Alternatively, the coder could report code 69210 twice with modifiers -LT (left side) and -RT (right side).
Does CPT code 69210 need a modifier?
When you are using 69210 for ear wax impaction, it is appropriate to use an E/M code (with modifier -25) if the patient received a true evaluation and management for a separate problem (such as bronchitis or pharyngitis) or for complicating problems (such as dizziness or otitis media).
Who can Bill 69210?
Historically, many payers have required a physician to provide the service. Some payers continue to observe this restriction, while others may allow an NPP (such as nurse practitioner, physician assistant, or clinical nurse specialist) to perform and report 69210.
Can CPT code 69210 be billed with 50 modifier?
Reporting 69210 Documentation should indicate the equipment used to provide the service. CPT® considers this procedure unilateral and states, “For bilateral procedure, report 69210 with modifier 50.” Contradictory to CPT®, Medicare considers this a bilateral procedure and prices it as such.
How do you bill for ear cleaning?
A new CPT code, 69209, provides a specific billing code for removal of impacted cerumen using irrigation/lavage. Like CPT 69210, (removal of impacted cerumen requiring instrumentation, unilateral) 69209 requires that a physician or qualified healthcare professional make the decision to irrigate/lavage.
Does Medicare pay for bilateral cerumen removal?
If the provider removes impacted cerumen from both the right and left ears, you may report a bilateral procedure. In other words: Medicare won’t pay anything extra if you report cerumen removal bilaterally.
Medicare reimbursement for 69210 will only be made for one unit of service, regardless of whether one or two ears are involved. UCare will follow Medicare guidelines and will process claims for procedure code 69210 based on a unit of one. Claims submitted with a -50 modifier will deny.
Is 69210 an unilateral or bilateral code?
Removal of cerumen that does not meet the criteria required under the new definition is considered to be included in the evaluation and management service rendered. procedure also defines procedure code 69210 as a “unilateral” procedure that should be reported using a -50 modifier (bilateral procedure) if performed on both ears.
Do you need a modifier for 69210?
The doctor detects impacted cerumen and removes it, billing 69210. Although modifier -25 is not technically required because 69210 is not a starred procedure and not bundled with 99392 ( early childhood [age 1 through 4 years]), you should still use the modifier.
Does CPT 69209 require a modifier?
For removal by irrigation, 69209 is the correct code. 69209 may be billed with modifier 50 if the procedure was done for both ears.
