Bilateral Procedures for Migrated Members

As Blue Cross Blue Shield of North Dakota (BCBSND) transitions to our new claims platform, please note that there will be new requirements in place for migrated members when billing for bilateral procedures. You can locate Reimbursement policies at

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” – Bilateral

  • Bilateral 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.