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CPT codes, descriptions, and other data only are copyright 2008 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.

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South Carolina Part B Carrier
Bilateral Services: Pulmonary Procedures

Procedures for submitting bilateral services to Medicare vary depending on the specific procedure. By submitting accurate claims the first time, you can reduce the number of denials and appeals.

  • The Medicare Physician Fee Schedule database (MPFSDB) designates procedure codes that may be submitted with CPT modifier 50. The MPFSDB assigns a bilateral indicator to each procedure.
  • Procedures performed on midline organs cannot be submitted as bilateral.
Steps to determine the MPFSDB bilateral indicator:
  • Access the database directly from the CMS Web site at www.cms.hhs.gov/PFSlookup/
  • Under Type of Information, select Payment Policy Indicators
  • Select 'Next'
  • Enter the procedure code and select 'All Modifiers'
  • Refer to the column heading 'Bilat'
Bilateral Indicator
Example CPT Codes
Explanation
0
 31629: bronchoscopy with needle biopsy

32442: sleeve pneumonectomy

32480: partial removal of lung

32650: thoracoscopy		 The 150% adjustment for bilateral procedures does not apply.
  • Do not submit codes with bilateral indicator 2 with HCPCS modifier RT or LT or CPT modifier 50
  • The bilateral adjustment is not appropriate for codes with Indicator '0' because of (a) physiology or anatomy, or (b) because the code descriptor specifically states that it is a unilateral procedure and there is an existing code for a bilateral procedure.
1
 32020: insertion of chest tube

32491: lung volume reduction surgery (LVRS)		 The 150% adjustment for bilateral procedures applies.
  • Report bilateral procedures with CPT modifier 50 and a quantity of '1' or
  • Report on 2 separate detail lines with HCPCS modifiers RT and LT
2
 30906: repeat control of nosebleed

31231: nasal endoscopy, diagnostic		 The 150% adjustment for bilateral procedures does not apply.
  • Do not submit codes with bilateral indicator 2 with HCPCS modifier RT or LT or CPT modifier 50. These claims will be rejected as 'billing errors' and must be corrected and resubmitted as new claims.
  • The Relative Value Units (RVUs) are already based on the procedure being performed as a bilateral procedure

Reference:
  • Complete definitions of bilateral indicators are available in CMS Pub. 100-04, chapter 23 (PDF, 1.28 MB), in the Addendum following section 90 (field 22 of the MPFSDB layout)

 

last updated on 02/20/2008
CMS