modifier 50

Proper Use of Modifier 50 (2021)

Novitas Solutions recently released a Modifier 50 Fact Sheet. It’s reminding to medical coders of the proper use for this CPT payment modifier. 

The Medicare Administrative Contractor (MAC) for Jurisdictions H and L warns that, effective for Part B claims received on and after Aug. 16, 2019, services will be rejected as unprocessable when modifier 50 Bilateral procedure is used inappropriately. 

When is the right time to append modifier 50? 

  • Modifier 50 may be appropriate if the bilateral indicator is 1 or 3. 
  • Do not append modifier 50 to a code with a bilateral surgery indicator of 0, 2 or 9. 

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 same side of body.
  • Modifier 50 cannot be appended when bilateral indicators are 0, 2, or 9. 

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) 

Click Here to verify the B/L modifier Indicator 

Additional Information: 

Don’t Report Modifiers 50 and 78 Together, 

  • If a (subsequent) bilateral procedure requires a return to the operating room after the initial surgery, and the bilateral indicator in the MPFSDB is 1 or 2, do not submit CPT modifier 50. 
  • CPT modifiers 50 and 78 cannot be submitted for the same service. Instead, submit the surgery procedure code with CPT modifier 78 and HCPCS modifier RT on one line, and submit the same surgery procedure code with CPT modifier 78 and HCPCS modifier LT on a separate detail line.

Click Here for more information

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