Read Bilateral Services and CPT Modifier 50 text version

Bilateral Services and CPT Modifier 50

Bilateral services are procedures performed on both sides of the body during the same operative session or on the same day. The modifier "50" is not applicable to procedures that are bilateral by definition or their descriptions include the terminology "bilateral" or "unilateral". Modifier "50" should follow the procedure code in box 24d of the HCFA-1500 claim form, or in the equivalent electronic field, when services are rendered bilaterally (unless the code does not require this modifier as described above). Generally, Modifier "50" is used to report bilateral diagnostic and surgical procedures. Modifier "50" applies to any procedure performed on both sides at the same session. Do not use modifiers "RT" and "LT" when modifier "50" applies. HealthPartners requires bilateral procedures to be reported on one line using modifier "50" with a unit of service of one. Where applicable, HealthPartners would reimburse 150% of the allowed amount. Example - Correct submission: 69806 with 1 unit of service Example - Incorrect submission: 69806 with 1 unit of service 69806-50 with 1 unit of service

NOTE: Use of modifiers applies to services/procedures performed on the same calendar day. HealthPartners uses the Medicare Physician Fee Schedule Database (MPFSDB) as the basis for determining which CPT codes should be submitted as "bilateral" (i.e. requires the use of the "50" modifier on one line item). The "Bilateral Surgery Indicator" (Field 22) in the MPFSDB indicates how the bilateral service must be submitted to Medicare.

·

To access this database, refer to the CMS Web site at: http://www.cms.hhs.gov/apps/pfslookup/step0.asp.

Bilateral Surgery Indicators and Claim Submission Bilateral Indicator 0 Definition Reimbursement of 150% for bilateral procedures does not apply. Reimbursement of 150% for bilateral procedure applies Reimbursement of 150% does not apply. Submission Instructions Do not submit these procedures with CPT modifier "50". Submit the procedure on a single detail line with CPT modifier "50" and a quantity of "1." Submit the procedure with a quantity of "1." Do not submit these procedures with CPT modifier "50". Submit the procedure on a single line with CPT modifier "50" and a quantity of "2." Do not submit these procedures with CPT modifier "50".

1

2

3

The usual payment adjustment for bilateral procedures does not apply. Bilateral concept does not apply.

9

9/11/2007

Information

Bilateral Services and CPT Modifier 50

1 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

1159492


You might also be interested in

BETA
Microsoft Word - billing and medical record documentation 08_1_06.doc
Microsoft Word - 2011 AMGA Survey Instructions.docx
Coding for Orthognathic Surgery
Layout 1
Microsoft Word - Section L_Jan2009.doc