AAPC - Back to school
Results 1 to 4 of 4

Thread: Bilateral Procedure with Wellcare

  1. #1
    Join Date
    Apr 2007
    Gainesville, GA

    Default Bilateral Procedure with Wellcare

    AAPC: Back to School
    I have a co-worker whom is having a difficult time getting wellcare to pay for bilateral procedures. Is there anyone here that can help me to give her some ideas. She has tried seperate line items, & modifiers and still no payment. She is not having any luck from Wellcare with any suggestions on how to get this paid timely.

    Lisa D

  2. #2
    Join Date
    Apr 2007


    I work for an ASC and below is some information about bilateral procedures when you billing Medicare. If i'm not mistaken Wellcare goes by Medicare Guidelines...This information might help

    Billing Bilateral Procedures
    Bilateral procedures should be reported as a single unit on two separate lines or with 2” in the units field on one line, in order for both procedures to be paid. While use of the -50 modifier is not prohibited according to Medicare billing instructions, the modifier is not recognized for payment purposes and if used, may result in incorrect payment to ASCs. The multiple procedure reduction of 50 percent will apply to all bilateral procedures subject to multiple procedure discounting.

    You can also choose to do the cpt code per line + modifier LT and RT; example: 15823-LT + 15823-RT

  3. #3

    Default Bilateral procedures

    I am having a difficult time finding resources on which insurance companies accept the one-line method for reporting bilateral procedures and which insurance companies accept the two-line method for reporting bilateral procedures. I have only confirmed through EOB denials that BCBS accepts the two-line method and Humana accepts the one-line method Does anyone know of any resources that would have this information? I have searched carrier websites, the managed care manuals and nothing specific to this. Thanks for any help!

  4. #4

    Default Modifier 50

    The procedure should be billed on one line with modifier 50 and quantity of "1"

Similar Threads

  1. Question on bilateral procedure
    By coder1013 in forum Diagnosis Coding
    Replies: 3
    Last Post: 05-06-2015, 09:46 AM
  2. Bilateral Procedure Question
    By angieboore in forum Billing/Reimbursement
    Replies: 2
    Last Post: 04-30-2015, 12:30 PM
  3. Bilateral Surgical Procedure Billing
    By tree in forum Modifiers
    Replies: 1
    Last Post: 05-07-2013, 07:23 AM
  4. 71100 and bilateral procedure
    By miugu in forum Outpatient Facilities
    Replies: 0
    Last Post: 04-17-2013, 10:15 AM
  5. Bilateral Procedure Question
    By lrountree in forum Medical Coding General Discussion
    Replies: 7
    Last Post: 03-19-2010, 09:14 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.