JUL 31, 2019
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.