HCPCS Modifier RT


Description
Right side (used to identify procedures performed on the right side of the body).

Guidelines and Instructions
Refer to the Medicare Physician Fee Schedule database (MPFSDB) to determine if HCPCS modifier RT is applicable to a particular procedure code.

Steps
  • Access the database directly from the CMS website 
  • Select Physician Fee Schedule Search from the left area of the web page
  • Screen defaults to current year. Under "Type of Information," select Payment Policy Indicators, then Next.
  • On the "Select Field Options" screen, select Next
  • Enter the procedure code and select All Modifiers, then click Update Results 
  • On the right side select Show All Columns
  • Scroll to the right and refer to the column heading "Bilat"
  • Indicator 0: HCPCS modifier RT can be submitted with these codes. The 150 percent adjustment for bilateral procedures does not apply. Payment will be based on the lower of the actual charge for both sides or 100 percent of the fee schedule amount for a single code. 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.
  • Indicator 1: HCPCS modifier RT cannot be submitted with these codes. The 150 percent adjustment for bilateral procedures applies. The code must be reported with CPT modifier 50. When the code is reported with CPT modifier 50, payment will be based on the lower of the total actual charge for both sides or 150 percent of the fee schedule amount for a single code. Note that the bilateral pricing rules are applied before other multiple procedure rules. Submission of modifiers other than 50 may result in a denial.
  • Indicator 2: The 150 percent adjustment for bilateral procedures does not apply. The Relative Value Units (RVUs) are already based on the procedure being performed as a bilateral procedure. If the code is reported with CPT modifier 50 or is reported twice on a single date, payment will be based on the lower of the total actual charges by the physician for both sides or 100 percent of the fee schedule amount for a single code. If codes with bilateral indicator 2 are submitted with HCPCS modifier RT or LT or CPT modifier 50, the claim will be rejected as a billing error. These claims must be corrected and resubmitted as new claims. If the procedure is performed on only the right side of the body, submit the service with CPT modifier 52 (refer to separate instructions for CPT modifier 52). 

Reference: Complete definitions of MPFSDB indicators are available in CMS Pub. 100-04, chapter 23, section 30.2.2 (PDF, 817 KB).





Last Updated: 07/16/2020