CPT Modifier 50

Published 12/02/2024

Description
Bilateral procedure.

Guidelines and Instructions
Refer to the Medicare Physician Fee Schedule database (MPFSDB) to determine if CPT modifier 50 is applicable to a particular procedure code.

  • Do not submit CPT modifier 50 on procedures for midline organs such as the bladder, uterus, esophagus and nasal septum
  • If a (subsequent) bilateral procedure requires a return to the operating room after the initial surgery, and the bilateral indicator in the MPFSDB is 1 or 2, do not submit CPT modifier 50. CPT modifiers 50 and 78 cannot be submitted for the same service. Bilateral rules are not applicable when CPT modifier 78 applies. 
  • For services with a bilateral indicator of 3, modifier 50 and a quantity of "2" should be reported.  See additional information below. 
  • Do not submit CPT modifier 50 on Ambulatory Surgical Center (ASC) services. See IOM Publication 100-4, Chapter 14, Section 40.5 for bilateral ASC submissions.

Steps
Access the Fee Schedule database on the Palmetto GBA website.

 Indicator Number
 Description
0
The 150 percent adjustment for bilateral procedures does not apply. Do not submit codes with bilateral indicator "0" with HCPCS modifier RT or LT or CPT modifier 50. Submission of these modifiers may result in a denial. 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.
1
The 150 percent adjustment for bilateral procedures applies. Bilateral procedures must be reported with CPT modifier 50 and a quantity of "1." 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.
2
The 150 percent 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 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.
3
The 150 percent adjustment for bilateral procedures does not apply. Payment will be based on the lower of 100 percent of the fee schedule for each side or actual charges for each side. Report bilateral procedures with CPT modifier 50 and a quantity of "2" or report on separate detail lines with HCPCS modifiers RT and LT. Services in this category are generally radiology procedures or other diagnostic tests which are not subject to the special payment rules for other bilateral procedures. 
9
Concept does not apply. This indicator often appears in the CO SURG column for nonsurgical procedures.  

References


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