billing 82947 and 82962 together with modifier 59 and hospital billing E0202


Can you charge for CPT code 82947 and 82962 on the same day and use modifier 59 
Ans :

Note : Only one laboratory service is reimbursable when duplicate services are submitted from the same group physician or other health care professional. Duplicate laboratory services are defined as identical or equivalent bundled laboratory component codes, submitted for the same patient on the same date of service. For purposes of this policy, CPT codes 82947 and 82948 are excluded from the duplicate laboratory charge review.

Separate consideration will be given to repeat procedures (i.e., two procedures performed the same day) by the same group physician or other health care professional when reported appropriately with modifier 76, 91 or a genetic testing code modifier included in Appendix I of the CPT book. Modifier 77 is appropriate when the repeat service is performed by a different physician in the same group with the same Federal Tax Identification number.

Can hospital bill E0202

Ans : Yes but is only bill for DME.

Note : The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. The light/lamp is adjudicated under DME and nursing services under home health. Home phototherapy may be used as an alternative to hospital phototherapy. This policy does not imply that home phototherapy should replace hospital phototherapy, or that hospital phototherapy for infants who are eligible for home phototherapy should be considered not medically necessary.

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