Friday, August 6, 2010

Medicare modifier 50 - bilateral procedure

Modifier 50 Fact Sheet

Definition:

• Bilateral Procedure performed at the same session on an anatomical site.

Appropriate Usage:

• When the procedure is done bilaterally AND the MPFSDB indicator for the procedure is "1" or "3" report the procedure code once; append with modifier 50 and report with one unit of service.
• Appropriate use occurs when the performing services on two bilateral body parts.

Inappropriate Usage:

• Reporting this modifier when the performing the service on different areas of the same side of the body.
• The BILT SURG indicator is 0, 2, or 9.
• When removing a lesion on the right arm and one on the left arm.
• On a procedure code that is described as bilateral in its CPT description.
• Do not report a bilateral procedure on two lines of service and append modifier 50 to the second line of service.

Additional Information:

When submitting modifier 50 appropriately Medicare’s reimbursement for the surgical procedure is 150 percent of the fee schedule.

Providers billing a procedure code/modifier combination inappropriately will result in an unprocessable denial.

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