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Wiki Pain management modifier 50

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cherylbr

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We have always been told when billing Medicare for bilateral procedures to use modifier 50. ex. 20160 50. Recently we have been receiving rejections from Medicare stating the procedure code is inconsistent with the modifier used or a required modifier is missing. When contacting Medicare they are now stating we need to billing with modifier RT and LT. We cannot find any new policy related to this for either the Professional side of billing or/and the Facility side of billing. Has anyone else come across this issue recently?
 
I would ask if they have these instructions in writing on their website if this for professional service or hospital facility fee, which both follow use of modifier 50 for procedures that are performed bilaterally.

If this a ASC facility fee then RT & LT could be required.
 
CHERYLBR

That is how I bill it and havne't had any issues with Medicare. I would follow up with them to see if something changed. But perhaps your jurisdiction changed its bilateral methods. I am juristiction K. I would check their billing guidelines on their website.

Also is it for all cpt codes?

Sorry I couldn't help.

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management.
 
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