Medical Billing Services

Modifier 50 Fact Sheet

Modifier 50

  • Modifier 50 applies to bilateral procedures performed on both sides of the body during the same operative session.
  • When a procedure is identified by the terminology as bilateral or unilateral, the 50 modifier is not reported.
  • If a procedure is authorized for the 150 percent payment adjustment for bilateral procedures (payment policy indicator 1), the procedure should be reported on a single line item with the 50 modifier and one service unit.
  • Whenever the 50 modifier is appended, the appropriate number of service units is one.
  • Modifiers LT (left side) and RT (right side) are not to be reported when the 50 modifier applies.
  • Claims with the LT and RT modifiers will be returned to the provider (RTP) when modifier 50 applies

Effective for claims received on and after August 16, 2019, services will be rejected as un-processable when the procedure code reported is inconsistent with the modifier used. The modifier 50 is defined as a bilateral procedure performed on both sides of the body.

Appropriate Use

  • Report one line with modifier 50 using one unit of service
  • If more than one bilateral procedure was performed the number of units should be adjusted to reflect the number of bilateral procedures that are performed.

Note: It is recommended that anatomical modifier be included in addition to the 50 modifier to show the additional services are not duplicates.

Example:

Procedure code 19303 (Mastectomy, simple, complete) is performed bilaterally

Correct Coding

Date of Service

Procedure Code

Modifier

Units

7/1/2019

19303

50

1

Incorrect Coding

Date of Service

Procedure Code

Modifier

Units

7/1/2019

19303

LT

1

7/1/2019 19303 RT

1

Inappropriate Use

  • Inappropriate to apply to a “bilateral description” code.
  • Do not append to procedures for midline organs such as the bladder, uterus, esophagus or nasal septum.
  • Inappropriate to report when performed on different areas of the same side of the body.
  • Modifier 50 cannot be appended when bilateral indicators are 0, 2, or 9.

Example:

The terminology for procedure code 27158 (osteotomy, pelvis, bilateral) indicates the procedure is performed bilaterally. Therefore, it’s not appropriate to report modifier 50 with this procedure code.

Bilateral Surgery Indicators

  • “0″ indicates a unilateral code; Modifier 50 is not billable.
  • “1” indicates modifier 50 can be appropriate.
  • “2” indicates a bilateral code; modifier 50 is not billable.
  • “3” indicates primary radiology codes; modifier 50 is billable.
  • “9” indicates that the concept does not apply. (office visit)

Medically Unlikely Edits (MUE) and Bilateral Procedures

When reporting bilateral surgical procedures that have an MUE Adjudication Indicator (MAI) of “2” or “3”, the bill with modifier 50 and one unit of service.

Ambulatory Surgical Centers (ASCs) and Modifier 50

Bilateral surgical procedures furnished by certified ASCs may be covered under Part B. While the use of the 50 modifier is not prohibited, according to Medicare billing instructions, the modifier is not recognized for payment purposes and if used, may result in incorrect payment to ASCs.

Bilateral procedures should be reported as a single unit on two separate lines or a single unit with “2” in the unit field on one line, in order for both procedures to be paid correctly. The multiple procedure reduction of 50 percent will apply to all bilateral procedures subject to multiple procedures discounting. Multiple surgery pricing applies to bilateral services (modifier 50) performed on the same day with other procedures.

Tags

Medical Billers and Coders

Catering to more than 40 specialties, medicalbillersandcoders is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.

Related Articles

Leave a Reply

Your email address will not be published. Required fields are marked *