• Bilateral Punctal Plug Denial

    Question: I performed bilateral punctal plugs and submitted to Novitas Medicare CPT code 68761 with modifier -50 and 1 unit. I received a denial due to incorrect modifier. Is there another modifier that should be used?

    Answer: Not all payers, including all Medicare Administrative Contractors (MACs), have the same claim submission requirements. Novitas has published that in addition to modifier -50, it requires the eyelid modifiers. Other payers may process without.

    E1 through E4 modifiers are defined below:
    E1 - Upper left, eyelid
    E2 - Lower left, eyelid
    E3 - Upper right, eyelid
    E4 - Lower right, eyelid

    Learn more about modifiers in the Essential Topics.