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25606 - is this a bilateral code?

C

coder32

Networker
Messages
45
Location
Spokane, WA
New to Orthopaedics. I have a break on the right and the left arm. Medicare states the code is bilateral but that's not in the description. So I need to bill with a modifier 50 and then adjust the cost to reflect both sides?
 
Its not a bilateral code, its unilateral thus under CMS if its done on both sides its reported with modifier 50 and cost adjusted to reflect both sides. Payment will be 150% of the medicare fee schedule to apply the 50% multiple procedure reduction on the second side. Some payers follow medicare and others want on separate lines with RT and LT modifier.

Bilateral codes are billed on one line with one unit since the fact its bilateral is already included in the RVU.

Here is some info from CMS

 
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