Wiki Bilateral Codes

Keres81

Networker
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Port St John, FL
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Can someone please post the link to CMS that has the page for Bilateral codes? I've looked all over their website and I would prefer taking on an actual Labyrinth instead.
The actual link, so that when I click on it it will take me right to the page, not the CMS homepage. Thank you for your help and if you're reading this, hope you had a Happy Holiday or Merry Christmas!
Thank you
Karri M.
CPC-A
 
Well actually CodingKing I think I put in the wrong terminology. What I meant was a page that listed all CPT Codes that are Unilateral and ones that are Bilateral. My apologies for the confusion ^_^

Karri M.
CPC-A
 
The article also talks about the Bilateral indicator which is on the Medicare Physician Fee Schedule. This what most payers use to determine what codes can be reported with the bilateral modifier.

If you download the RVU file it will show the indicators for each code

https://www.cms.gov/Medicare/Medica...=1&DLEntries=10&DLSort=0&DLSortDir=descending

The file inside the zip file is PPRRVU16_V1110_V2. Its in xls, csv & text format, use the one your software supports. Column BILAT SURG contains the indicators listed in the article in the post above.

If you need the full code descriptions you would have to pay AMA for one of their data files if your vendor doesn't provide them.

Another link describing thi bilateral surgery indicators:
https://www.noridianmedicare.com/provider/updates/docs/Bilateral_surgery_revised.pdf
BILAT SURG indicator

0 - Bilateral surgery rules do not apply. Do not use 50 modifier
1 - Bilateral surgery rules apply (150%). Use 50 modifier if bilateral. Units = 1.
2 - Bilateral surgery rules do not apply. Already priced as bilateral. Do not use 50 modifier. Units = 1.
3 - Bilateral surgery rules do not apply. Do not use 50 modifier. Units = 1 or 2.
9 - Bilateral surgery concept does not apply.
 
Last edited:
Hey CK

Thanks SO much for explaining that to me so that I can understand it better! This is gonna help me so much and bless you for taking the time to explain it to me in laymans terms. Take care and thanks again!
Karri M.
CPC-A
 
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