Implantation of Biologic Code (15777) Issue

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Question:

I’m using the new add-on code, 15777, for Alloderm placement when we do a breast reconstruction with tissue expander. However, we are having trouble getting paid on the code when we bill it bilaterally with modifier 50. Can you help?

Answer:

Yes, this has been a problem since the code came out in January 2012. CPT says modifier 50 is appropriate on 15777. However, Medicare (and some other payors) did not appropriately set up their payment systems to recognize modifier 50 on 15777. Medicare fixed this issue effective July 1, 2012. You should refile/appeal previous denials and hopefully be paid now.