Wiki Which payers want 50 mod vs LT/RT?

[Czimmer]

Does anyone happen to have a list of payers that want the RT/LT modifier with two lines, versus who wants one line with a 50 modifier?

Thank you!

 

[SheenaMcaloon]

In my experience, it really varies on the code your using , as well as the payer guideline.
here are some examples I have come across in my experience, that may help:

15734 or any flaps

DO NOT USE -50, LIST LT/RT - ANY PAYERS

8MEDICARE:
A mastectomy, CPT code 19303 (Mastectomy, simple, complete), is performed bilaterally.
Correct coding:

Date of service	Procedure code	Modifier	Units
6/1/2024	19303	50	1

Incorrect coding:

Date of service	Procedure code	Modifier	Units
6/1/2024	19303	LT	1
6/1/2024	19303	RT	1

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UHC
I have come to find seems to prefer the LT/RT vs the -50 but again just depends on the type of plan guidelines and what the codes intentions are/ locations etc:
"UnitedHealthcare will apply CMS’s payment adjustment methodology to bilateral eligible procedures with a bilateral indicator regardless of the Multiple Procedure Indicator when the procedure code is reported bilaterally with a modifier 50 or on separate lines with modifiers LT and RT for the same structure"