Awareness : Newsletter Articles

When Is It Appropriate to Bill Modifier 50?

Modifier 50 is used to report bilateral procedures performed during the same operative session as a single line item. Do not use modifiers RT and LT when modifier 50 applies. Do not submit two line items to report a bilateral procedure using modifier 50.
When submitting claims for bilateral surgery, use modifier 50 with the procedure code. Modifier 50 applies to any bilateral procedure performed on both sides at the same operative session, except as indicated below. The bilateral modifier 50 is restricted to operative sessions only.
Modifier 50 may not be used:

  • To report surgical procedures identified by their terminology as “bilateral,” or
  • To report surgical procedures identified by their terminology as “unilateral or bilateral,” regardless of whether the procedure, is performed bilaterally or not.
  • When billing claims for procedure codes that are bilateral in nature, regardless of whether these services are performed unilaterally or bilaterally, providers should bill the surgical procedure code as a single claim detail line item without modifier 50.

    Claims for bilateral surgical procedures should be billed on a single claim detail line with the appropriate procedure code and modifier 50 and one (1) unit of service (UOS). To determine if a procedure should be billed with the modifier 50 as a bilateral procedure, providers may access the Medicare Physician Fee Schedule (MPFS) look-up tool. Select MPFS, enter the procedure code, date of service and locality. Once you select “Submit,” the details relating to the procedure code will be revealed. Under the heading “Modifier,” scroll to the “Policy Indicator” section. The “Bilateral Surgery” indicator will advise if a modifier 50 should be billed with the code.