As a reminder, with the transition to the new claims platform, there are new requirements in place for migrated members when billing for bilateral procedures. The full reimbursement policy on this is located at www.BCBSND.com/web/providers/coding-reimbursement.
Bilateral procedures must be reported with the correct number of services to correspond with the modifier(s) reported.
Bilateral billing for Physicians
- “Right” and “Left” modifiers
- Bilateral services reported on two lines of service must include an RT modifier on one line and an LT modifier on the other. The number of units on each line should be one.
- Bilateral services reported on one line of service must include both RT and LT modifiers. The number of services should be two.
- Modifier “50”
- BilateralBilateral procedures performed at the same operative session should be reported on one line with a “50” modifier to indicate bilateral procedures. The number of units should be two.
The CPT® descriptions for some procedures specify that the procedure is bilateral or that it is inherently considered bilateral. In such cases, the bilateral modifier should not be used. The number of units should be one.
Bilateral procedures performed during the same operative session as other surgical procedures may be subject to a multiple-surgery reduction.
Bilateral billing for Ambulatory Surgical Centers
Modifier -50 should be used on surgical services that can be performed bilaterally and are not already defined as a bilateral service. When appropriate, report the service appended with the -50 modifier on one line with two units.
Bilateral billing for Hospital Outpatient Services
Bilateral services should be reported on two lines of service. The number of units on each line should be one. Modifier -50 may be appended to one of the lines, but a bilateral procedure cannot be billed as only one line with modifier -50.
Bilateral billing for Radiology Procedures
Professional bilateral radiology services are reported as two lines with -LT and -RT modifiers. The number of units should be one.