Bilateral Procedure Codes List

A procedure that is identified by its descriptor as a bilateral procedure (o

r unilateral or bilateral), as in codes 27395 and 52290 listed above, requires the physician to not report the procedure with the 50 modifier. Ambulatory Surgical Centers (ASCs) cannot append the 50 modifier on bilateral surgery claims.

If the code has an indicator of two, it is a bilateral procedure code. You w

ould not need to add a modifier 50 because the code is already bilateral. A code with this indicator lets the insurance company know that both sides were done. Claims will be processed at 100% of the allowable.

Effective for claims received on and after August 16, 2019, services will be

rejected as unprocessable when the procedure code reported is inconsistent with the modifier used. The Medicare physician fee schedule status indicators for bilateral services should be used to determine if the procedure is allowed to be performed bilaterally.

Description A Bilateral Indicator of "3" indicates the usual payment adjustm

ent for bilateral procedures does not apply. If the procedure is reported with either a modifier 50 or modifiers RT and LT, and a ‘2’ in the units field, reimbursement is based on 100% of the Medicare allowed amount for each side less any applicable multiple procedure pricing rules.

CPT or HCPCS codes that are bilateral in intent or have bilateral in their d

escription should not be reported with the bilateral modifier 50 or modifiers LT and RT because the code is inclusive of the bilateral procedure. CMS has updated its policies concerning the appropriate use and reporting of these modifiers. For this policy, servicing practitioners reporting under the same Tax ID number ...

CPT® Codes Lookup. Current Procedural Terminology, more commonly known as C

PT®, refers to a medical code set created and maintained by the American Medical Association — and used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to represent the services and procedures they perform.

Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in

conjunction with a congenital heart procedure (List separately in addition to code for primary procedure). 33930: Cardiovascular: Donor cardiectomy-pneumonectomy, with preparation and maintenance of allograft. 33935: Cardiovascular

CPT Modifier 50 Bilateral Procedures – Professional Claims Only Modifier 5

0 is used to report bilateral procedures that are performed during the same operative session by the same physician in either separate operative areas (e.g. hands, feet, legs, arms, ears), or one (same) operative area (e.g. nose, eyes, breasts).

Bilateral Indicator: What Does this Bilateral Indicator Mean? 0 No bilateral

payment adjustment 150% payment adjustment for bilateral procedures does not apply.If procedure is reported with modifier -50 or with modifiers RT and LT, base the payment for the two sides on the lower of: (a) the total actual charge for both sides and (b) 100% of the fee schedule amount for a single code.

Disclaimer: The information here is NOT meant to replace the sound advice of

a billing and coding expert.. Below is a list of the most common CPT codes (procedure codes) used in a PM&R and interventional pain management clinic. Electrodiagnostic (EMG/NCS) codes are also included. These have all been updated for the most recent 2017 changes.

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with deco

mpression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure)

X Ray CPT CODES another list 72010 x-ray spine entire 72020 x-ray spine, 1 v

iew 72040 xray spine cervical 2-3 views 72050 x-ray, spine cervical 4+ views 72052 x-ray spine cervical complete, 72069 x-ray spine standing for thoracolumbar 72070 x-ray spine thoracic 2 views 72072 x-ray spine thoracic 3 views 72074 x-ray, spine thoracic 4+ views

The terminology for procedure code 27158 (osteotomy, pelvis, bilateral) indi

cates the procedure is performed bilaterally. Therefore, it’s not appropriate to report modifier 50 with this procedure code.

The codes listed in this policy are for reference purposes only, this listin

g does not mean teh procedure is covered. Be sure to verify the patients benefits and eligibility. This list of CPT® Codes may not be all inclusive.

Correct submission of a bilateral procedure is the code on one line with Mod

ifier 50 and “1” in the units field. For all professional and facility claims, bilateral procedures are reimbursed as follows: 1. The primary bilateral procedures are reimbursed at 150 percent of the allowable charge. 2. The secondary bilateral procedures are ...

The procedure codes are defined by CPT/HCPCS as primarily bilateral or a bil

ateral service, since the allowed amounts for these procedure codes are already inclusive of the bilateral procedure. Appended to a bilateral procedure performed on a different area of the right and left sides of the body (modifier RT/LT).

To help with this, if the same procedure was performed on both sides of the

body you would report one CPT with modifier 50. You will need to be careful when the code descriptor is indicated as “bilateral or unilateral. Many coders feel the need to place lateral/bilateral modifiers on the excision of skin lesion CPT codes for different sides ...

Bilateral procedures rendered by a physician that has reassigned their billi

ng rights to a Method II CAH are payable by Medicare when the procedure is authorized as a bilateral procedure and is billed on TOB 85X with revenue code (RC) 96X, 97X or 98X and the 50 modifier (bilateral procedure).

Visual Field Examination, Unilateral or Bilateral, with Medical Diagnostic E

valuation; Extended Examination (e.g., Goldmann Visual Fields with at Least 3 Isopters Plotted and Static Determination within the Central 300, or Quantitative, Automated Threshold Perimetry, Octopus Program G-1, 32 or 42, Humprey Visual Field Analyzer Full Threshold ...

As diagnostic codes change annually, you should reference the current versio

n of published coding guidelines and/or recommendations from nationally recognized coding organizations for the most detailed and up-to-date information. No copy or use beyond the online access or internal use of this presentation by an individual provider office should ...

CMS Definition for Bilateral Status Indicators. 0. 150 percent payment adjus

tment for bilateral procedures does not apply.The bilateral adjustment is inappropriate for codes with this indicator because of physiology anatomy or because the code descriptor specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure.

Find ICD-10-PCS procedure codes by code name, code description or procedure

section. Partial searches are allowed. Result set includes valid for submission marker. Search. The CMS ICD-10 Procedure Coding System (ICD-10-PCS) is a catalog of procedural codes used by medical professionals for hospital inpatient healthcare settings. The Centers for ...

The lower of the actual submitted charge for both procedures or 100% of the

fee schedule amount for a single procedure. Payment is not increased for these procedures because physiology or anatomy are not appropriate (e.g., surgeries on the large intestine), or because the code descriptor specifies that it is a unilateral procedure and there is an existing code for a bilateral procedure.

2021 ICD-10-PCS Codes ICD-10-PCS is a procedure classification published by

the United States for classifying procedures performed in hospital inpatient health care settings. 0 Medical and Surgical

The Ultrasound CPT Codes and Reimbursement lists below are completely search

able and sortable by column to make it easier for you to find any Ultrasound CPT Code for 2020. Whether you are billing for ultrasounds in the emergency department, clinic, office, outpatient, or inpatient settings we hope you find this helpful.

CPT ® - Current Procedural Terminology ® Medical Code Set (00000-99999, -F

, -M, -T, -U). The Current Procedural Terminology (CPT) code set is maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set accurately describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures ...

A: The coder would report CPT code 69210 (removal impacted cerumen requiring

instrumentation, unilateral) with modifier -50 (bilateral procedure) twice. Alternatively, the coder could report code 69210 twice with modifiers -LT (left side) and -RT (right side).

Modifier 50: Bilateral Procedures. For Bilateral procedures, use the -50 or

-RT/-LT modifiers when an identical procedure is performed on both the Right and Left sides of the body. The policies payors have for the use of modifiers for reporting bilateral procedures can vary. Check with each payor for their preferred method of billing bilateral ...

for bilateral procedures. For a list of local BCBS Association companies, go

to www.bcbs. com/about-the-companies/; bilateral procedure rules will be listed under “Provider” and “Guidelines and Policies.” Another variation for reporting bilateral procedures with modifier 50: the code is billed on two lines, each with 1 unit, and

The CPT 2020 code set includes a change seen (parenthetical guidelines) thro

ughout the CPT Manual for reporting of bilateral services for add-on codes. Effective January 1, 2020, and as noted in Appendix A of the CPT code book, it is no longer appropriate to append Modifier 50 to add-on codes.

For a bilateral breast ultrasound, a modifier 50 should be added to either 7

6641 or 76642 to indicate a bilateral procedure. The 2015 Medicare Physician Fee Schedule assigns a “1” bilateral indicator to both CPT codes 76641 and 76642 which means that Medicare will allow 150 percent of the standard reimbursement rate.

CPT® 77066 – Diagnostic mammography, including computer-aided detection (

CAD) when performed; bilateral G0279 – Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) Digital breast tomosynthesis codes 77061-77062 should not be reported if 2D and 3D views have been taken.