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Printed Date: 9/22/2015
Indicator 0: HCPCS modifier LT 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 physiology or anatomy, or 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 LT 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 left side of the body, submit the service with CPT modifier 52 (refer to separate instructions for CPT modifier 52).
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Last Updated: 07/16/2020