Modifier 50 | Bilateral Procedures Explained

Modifier 50 describes a CPT code modifier used to indicate that a diagnostic, radiology or surgical procedure was performed on both sides of the body during the same operative session.

1. What is modifier 50?

Modifier 50 is a CPT code modifier used to indicate that a diagnostic, radiology or surgical procedure was performed on both sides of the body during the same operative session. It is also known as the “bilateral procedure” modifier.

2. When to use the 50 modifier?

Modifier 50 should be used when a provider performs a procedure on both sides of the body during the same operative session.

It applies to procedures performed on paired organs or body structures, such as extremities, eyes, and ears. However, it should not be used with add-on codes or for services performed on different extremities of the same side.

3. Description

The official description of modifier 50 is “bilateral procedure”.

4. Examples

Examples of procedures that require modifier 50 include bilateral mammography, bilateral cataract surgery, and bilateral hip replacement surgery.

5. Documentation

Documentation requirements for modifier 50 include clear and concise documentation of the procedure performed on both sides of the body during the same operative session. The documentation should also include the reason for the bilateral procedure.

6. Billing

When billing for a procedure with modifier 50, some payers may require the provider to report two service units. Other payers may require the provider to submit a claim showing the procedure code twice, once with modifier LT on the left side and once with modifier RT on the right side, with one service unit for each.

7. Common mistakes

Common mistakes when using modifier 50 include using it with add-on codes, using it for services performed on different extremities of the same side, and failing to check the coding accuracy in Column T of the Medicare Physician Fee Schedule database.

8. Other modifiers related to modifier 50

Other modifiers related to modifier 50 include modifier LT and modifier RT, which indicate that a procedure was performed on the left or right side of the body, respectively. These modifiers can be combined or singly to make the claim more specific.

9. Tips

Some tips for using modifier 50 include checking the coding accuracy in Column T of the Medicare Physician Fee Schedule database, ensuring that the documentation indicates that the procedure was performed on both sides of the body during the same operative session, and following the billing guidelines of the payer.

10. Conclusion

Modifier 50 indicates that a procedure was performed on both sides of the body during the same operative session. It is important to follow the requirements and guidelines for using this modifier to ensure accurate billing and reimbursement.