What We’re Reading – Bilateral procedures and MUEs

Are you stumped on when to use modifier 50 instead of modifiers LT and/or RT for Medicare? Modifier 50 is defined as a bilateral procedure which is performed on both sides of the body in the same operative session or on the same day.  If, however, the description of the CPT (Current Procedural Terminology) code specifies that the code is for a unilateral and/or bilateral procedure, modifier 50 would not be appropriate. Unilateral injections are performed on one side of the joint, while bilateral injections are performed on the right and left side of the joint. For example, for CPT code 64479, you would use modifier LT or RT if the procedure was only performed on one side.  If injection was on both sides of the joint, you would use modifier 50.

The First Coast Service Options website provides a great resource to help you determine if modifier 50 should be used: the Medicare Physician Fee Schedule (MPFS) look-up tool under the indicator “bilateral surgery.” To find out more details refer back to First Coast Service Options billing news.  Remember also that not all payors use Medicare’s guidelines so check with each one to understand its billing rules for these modifiers.

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