Friday, March 25, 2016

How to use Bilateral Services and CPT Modifier -50 and payment policy

Description

Bilateral services are procedures performed on both sides of the body during the same session or on the same day.

The HCPCS modifiers -LT and -RT are used when the procedure is valid for a modifier -50 procedure but the procedure is only performed on one side.

• As defined in the CPT, Modifier 50 “Bilateral Procedure: Unless otherwise identified in the listings, bilateral procedures that are performed at the same session should be identified by adding modifier 50 to the appropriate five digit code.”

• Modifier 50 is used to report diagnostic, radiology and surgical procedures. Modifier 50 applies to any bilateral procedure performed on both sides at the same session.

• Do not use Modifiers RT and LT when modifier 50 applies. A bilateral procedure is reported on one line, using modifier 50.

• Modifier 50 eligibility is based on procedure description, CPT guidelines, CMS directives and nationally recognized sources (e.g., Journal of AHIMA, CPT Assistant).

The modifier “50” is not applicable to:
• Procedures that are bilateral by definition.
• Procedures with descriptions including the terminology as “bilateral” or “unilateral.”


Harvard Pilgrim Reimburses1

Bilateral services performed on both sides of the body during the same session or on the same day at 150% of the fee schedule allowed amount.

• Bilateral payment adjustment applies to all providers except for those providers contracted as facility surgery case rate and percent of charge reimbursement methods.


Bilateral Service Billing
Bilateral services performed on both sides of the body during the same session or on the same day must be billed on a single detail line with CPT and modifier 50 appended.


Multiple Modifiers Billing
Modifier that reduces the fee schedule/allowable amount must be billed in the primary modifier position, and modifier 50 in the secondary position.

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