How many units of services should I submit when I am billing a bilateral surgical procedure with CPT modifier 50?

Answer

The units of service you should submit depends on the Medicare Physician Fee Schedule bilateral indicator assigned to the procedure code. 

  • If you are billing a bilateral surgical procedure, having a BILAT indicator of 1, you must submit CPT modifier 50, with 1 in the Quantity Billed field. Any other combination may result in a denial or an under payment.
  • If you are billing a bilateral procedure, having a BILAT indicator of 2, CPT modifier 50 or anatomic HCPCS modifiers (e.g. RT, LT, FA, F1-F9, TA, T1-T9, E1-E4), should not be submitted. These codes are considered bilateral and/or the code descriptions include possible multiple services. Any combination of these modifiers may result in a denial.
  • If you are billing a bilateral procedure, having a BILAT indicator of 3, CPT modifier 50 and anatomic HCPCS modifiers (e.g. RT, LT, FA, F1-F9, TA, T1-T9, E1-E4) may be submitted with the number of services performed indicated by utilizing the Quantity Billed field as appropriate

Refer to the Payment Policy Indicators on the CMS Medicare Physician Fee Schedule Database (MFSDB) to determine the bilateral (BILAT) indicator.

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