04/04/2023

Healthfirst Medicare-Refund for CPT 76942

I have been asked for money back from Healthfirst Medicare . Reason is : "service billed with invalid bilateral modifier" for code 76924 ultrasound guided injection

Healthfirst is requesting a partial refund because even if the ultrasound guidance is done bilaterally, it can only be billed once per day. The radiology item should have only been billed once on the claim with no modifier. Per CMS guidelines, it is not reasonable for any provider to bill more than one unit of service per patient. The money should be offset from a future payment to reflect the overpayment for the additional unit of the ultrasound.