Tuesday, June 21, 2011

Bilateral procedure code modifiers - RT, LT & 50 with example

Bilateral Procedures

Effective for dates of adjudication October 1, 2006 and thereafter the procedure for billing bilateral procedures changed. In the past, (through September 30, 2006), providers were instructed to bill for bilateral
procedures on one line with modifier 50. The reimbursement was adjusted to 150% of Medicaid’s fee schedule.

Effective for dates of adjudication October 1, 2006 and thereafter, the new procedure is as follows:

• Bill the appropriate procedure code on 2 separate lines with RT and LT modifier, or other appropriate anatomical modifier,

• Modifier 50 will be used for informational purposes only and is no longer a pricing modifier.

• The payment will be 100% of Medicaid fee schedule for first line and 50% for second line.

• Claims will be subject to multiple surgery payment adjustments for multiple procedures.

Example:
Line 1: 27558 RT
27558 LT; 50 (Optional use of modifier 50)

Alabama Medicaid utilizes Medicare’s RVU file to determine whether a 50 modifier, or RT and LT modifier should be allowed with the procedure code billed. When an inappropriate procedure code is billed with modifier 50, or RT and LT modifier, the claim will deny.


NOTE:

When Medicaid payment occurs for a procedure code billed inappropriately with modifier 50, AND/OR RT (right) AND/OR LT (left), the claim will be subject to a system adjustment in payment, post
payment review, and recoupment.

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