Number of Units for ADM Code (+15777)

Question:

I use two ADMs on each breast during a tissue expander reconstruction. Can I bill +15777 x 4 units?

Answer:

No, you’ll use the code +15777 once for each breast

Question:

I’m confused on whether to bill +15777 twice (once on each side) or with modifier 50. Please advise.

Answer:

Good question and we completely understand the confusion. CPT says not to use modifier 50 – rather, you’ll report +15777 x 2 units for bilateral procedures. However, Medicare’s Medically Unlikely Edits allow only 1 unit of +15777 to be paid per day. Therefore, for Medicare (and payors who follow Medicare guidelines), you’ll report +15777 with modifier 50 for bilateral procedures.

*This response is based on the best information available as of 04/01/21.