DecisionHealth, DecisionHealth - 2024 Issue 2 (February)

How to handle payer requirements that conflict with AMA guidelines

Question: According to one of our private carriers there are two possible ways we should report bilateral services with modifier 50 (Bilateral procedure):
  1. Report modifier 50 on two service lines with one unit each.
  2. Report modifier 50 on one service line with 2 units of service.
However, the carrier does not have this in their payment policies. In addition, this private payer’s instruction contradicts other private carriers and our Medicare administrative contractor (MAC). What should we do?

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