Wiki 50 Modifier vs Separate Lines

[youngva462@gmail.com]

How do yall find out/know if a CPT codes uses the 50 bilateral modifier or requires separate lines for each side?

I keep getting it wrong and I dont see anywhere in the CPT book that specifies.

 

[kkidd91]

How do yall find out/know if a CPT codes uses the 50 bilateral modifier or requires separate lines for each side?

I keep getting it wrong and I dont see anywhere in the CPT book that specifies.

I code for outpatient ASC, I think this may be payer driven, however the cases that I have encountered require separate lines for each side with their appropriate laterality modifier.

 

[csperoni]

For pro-fee, this is absolutely payor driven. Medicare guidelines are bill once, with -50 modifier. Almost all carriers I've come across follow that same guideline. I will occasionally run across a smaller payor who wants 2 lines - one with -RT and one with -LT. Most billing systems will allow you to build out a flag or somehow notify you before a claim goes out for a payor you've indicated that won't accept -50.

 

[catherinetinkey@entmedicalservices.org]

If a code states "unilateral or bilateral" in their description you cannot use a 50 modifier on it. Using a 50 modifier vs RT/LT is payer driven, most insurance companies have a Modifier 50 guidelines on their website.