April 1, 2021
I use two ADMs on each breast during a tissue expander reconstruction. Can I bill +15777 x 4 units?
No, you’ll use the code +15777 once for each breast
I’m confused on whether to bill +15777 twice (once on each side) or with modifier 50. Please advise.
Good question and we completely understand the confusion. CPT says not to use modifier 50 – rather, you’ll report +15777 x 2 units for bilateral procedures. However, Medicare’s Medically Unlikely Edits allow only 1 unit of +15777 to be paid per day. Therefore, for Medicare (and payors who follow Medicare guidelines), you’ll report +15777 with modifier 50 for bilateral procedures.
*This response is based on the best information available as of 04/1/21.