tci Part B Insider - 2008 Issue 30

Reader Question: One Size Doesn't Fit All When Reporting Bilateral Procedures With Modifiers

Payer policy reigns when it comes to selecting the right modifierQuestion: We performed a bilateral x-ray. Can we append modifier 50 to the code or should we bill it some other way?Answer: Although some experts advise using modifier 50 (Bilateral procedure) on all bilateral x-ray claims, that isn't always accurate. Although your payer may sometimes require you to use modifier 50 for bilateral claims, this is not true for all bilateral x-ray claims.Modifier 50 tells the payer that the provider performed a unilateral procedure (described by a unilateral CPT code) bilaterally during the same session.If a...

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