Using Procedure Modifiers 50 & 51

Modifier 50, Bilateral Procedures
Read the CPT code description closely. If it contains wording such as "unilateral" or "bilateral," the service is not valid for use of the 50 modifier.

• Modifier is used when an identical service is performed on both sides of a paired organ.
  
• Medicare bilateral procedure indicator is one or three.
• Submit a single claim line with the appropriate code and modifier 50 appended; report total units as "1."
  
• The single line will be reimbursed at 150% of the contracted fee when the 50 modifier is appended correctly.
  
• Multiple procedure reductions apply when multiple procedures are performed by the same physician on the same patient in the same surgical session.
• RT and LT does not take the place of the 50 modifier and should only be used for services rendered on one side of a paired organ.
• If billing on a UB 04, the bilateral procedure must be billed on two lines. The 50 modifier should only be put on the second line.

Bilateral Radiology Services

• Radiology procedures are not subject to the bilateral pricing methodology. They are reimbursed at 100% of fee schedule for each service rendered.
• Many radiology services can be reported with a bilateral modifier (services performed on both sides of a paired organ/structure), but read the CPT code description to ensure that it does not contain wording such as "unilateral" or "bilateral"
• Report 2 units for bilateral services when reporting on a single claim line, or 1 unit per line when reporting on two claim lines.

Modifier 51, Multiple Procedures
Also see Multiple Same-Day Procedures

• Modifier 51 is not required on claim lines when multiple procedures are performed on the same day. Priority Health will apply multiple same-day surgical logic based on our fee schedule amounts.
• Priority Health does not use Medicare's multiple endoscopic procedure methodology, but the services are subject to the same day multiple surgical reduction.
• Modifier 51 does not apply to procedures classified as "add-on" or "Modifier 51 exempt."
• Modifiers such as F- (finger), T- (toe), LT, and RT should be used to communicate locations/ anatomical sites and will be subject to the multiple same-day procedures reduction.
• The service with the highest allowed fee amount will be priced at 100% of the Priority Health fee schedule. Each additional same-day procedure will be priced at 50% of the fee, based on the lesser of billed charges or fee schedule amount.
• Multiple same-day procedure reduction will be identified as "MSD" on your remittance advice.