Medicaid modifiers
Effective January 1, 2012, Florida Medicaid will require either RT or LT modifiers on HCPCS drug codes related to intravitreal (eye) and intra-articular (knee) injections. The HCPCS codes listed below will require RT or LT modifiers. Additionally, the following modifiers may no longer be used: 22, 50, and/or 99. Using modifiers 22, 50, and/or 99 will cause the claim to reject.
Each submitted claim must reflect the anatomical site, right (RT) or left (LT), where the injection was administered. This modifier requirement is applicable when a patient receives a unilateral injection (one side), or bilateral injections (both sides) during a single visit. Bilateral injections on a single visit are to be billed in two (2) separate claims using RT and LT modifiers.
Procedure Codes
C9257 INJECTION, BEVACIZUMAB, 0.25 MG (AVASTIN)
J2503 INJECTION, PEGAPTANIB SODIUM, 0.3 MG (MACUGEN)
J2778 INJECTION, RANIBIZUMAB, 0.1 MG (LUCENTIS)
J7310 GANCICLOVIR, 4.5 MG, LONG-ACTING IMPLANT (VITRASERT)
J7311 FLUOCINOLONE ACETONIDE, INTRAVITREAL IMPLANT (RETISERT)
J7312 INJECTION, DEXAMETHASONE, INTRAVITREAL IMPLANT, 0.1 MG (OZURDEX)
J7321 HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTICULAR INJECTION, PER DOSE
J7323 HYALURONAN OR DERIVATIVE, EUFLEXXA, FOR INTRA-ARTICULAR INJECTION, PER DOSE
J7324 HYALURONAN OR DERIVATIVE, ORTHOVISC, FOR INTRA-ARTICULAR INJECTION, PER DOSE
J7325 HYALURONAN OR DERIVATIVE, SYNVISC OR SYNVISC-ONE, FOR INTRA-ARTICULAR, INJECTION, 1MG
J7326 HYALURONAN OR DERIVATIVE, GEL-ONE, FOR INTRA-ARTICULAR INJECTION, PER DOSE
