mod 50


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Does anyone know where I can find documentation that states that modifier 50 can only be applied on surgery codes?? I have reviewed all my books and have not found anywhere where it states that we can not apply modifier 50 to medical CPT and/or Xray CPTs. Then, if we can apply to any CPT, where does it state we can not reduce 50% for certain services.

I thought this pretty much depended on what the payor wants??? I looked in Appendix A of the CPT manual and it doesn't stipulate that this modifier is only for surgeries. On bilateral xrays, we bill the code on two lines and use RT/LT modifiers. Some payors want us to bill everything on one line and put modifier 50 for certain procedures. For example, VA Medicaid wants bilateral codes billed on one line with two units and no RT/LT modifier so for them, that's how we bill it.
Whether or not the 50 can be used depends on the CPT code. I would suggest checking the Physician Fee Schedule Look-up on the CMS website. You can put your CPT code in, and it will tell you if you can use the 50 mod with the code.

As far as I know, it can be used on some radiology codes, as well as surgery codes.
More Information Needed

I don't think you will find that information in any CPT book. I am not certain where you recieved that information but parenthetical notes throughout the CPT relay otherwise and I don't know of a payer that disputes the use of -50 or equivalen RT/LT when it is warranted.

You may be running into problems because of the codes that you are appending -50 to. Please provide more information. You may also have to use the guidelines to educate a misinformed payer if that is the source of your information.
Hi Dawn,

Medicare has an online tool that will allow you to enter a procedure code and obtain the payment policy indicators for it. Included in those indicators is a code which will tell you whether the bilateral surgery rules apply or not.

Call me and I can walk you through the process.

(904) 244-2158
Debbie A

I found a list of codes that can be used with modifier 50. I found the list on the Medicaid Website, under North Carolina Medicaid Special Bulletin. It is dated April 1999. There should be an updated list on the website. I do not have the actual web address.
Mod 50 is for Unilateral procedures

Hi there,
Did you know that modifier 50 is used only for unilateral procedures? Say if the left knee is injected and then the right knee is also injected, mod 50 is not appropriate. You would use mod 59 and maybe informational modifiers for R and L. The same would be true for X-rays or any other service. :eek:
Cindy R Walden, CPC-I
I would think that using modifier 50 would not be correct on an xray because most carriers use this modifier to make their fee schedules pay correctly at 150% of the price for a single code. On xrays, you would be entitled to the full fee schedule for each xray, which makes a single line item with LT & RT more correct for the payor. I'm not saying you couldn't use modifier 50, but you might not get paid correctly using it!
The description of Modifier 50 is as follows: Bilateral Procedure: Unless otherwise identified in the listings, bilateral procedures that are performed at the same operative session should be identified by adding modifier 50 to the appropraite five digit code. Operative session is the key word in this description - Medicare allows the use of Modifier 50 only with surgical procedures and only those that allow the modifier according to the Medicare Database..........
Modifier 50

By description of this modifier in the CPT 2008 Professional Edition, page 457 - "Bilateral Procedures - Unless otherwise identified in the listings, bilateral procedures that are performed at the same operative session should be identified by adding modifier 50 to the appropriate five digit code." Because it specifically states "same operative session" this indicates to this certified coder that it can only surgical codes codes. X-rays that are billed independently of surgical procedures, therefore, should not be billed with Mod 50. I can tell you that the insurance company I work for does not recognize Mod 50 on x-rays and only pays for 1 x-ray when providers bill Mod 50 on one line with a qty of 1.