Bill bilateral procedures separately starting Jun. 1, 2022

Starting Jun. 1, 2022, we’ll deny professional claims from Ambulatory Surgical Centers (ASCs) billed with Modifier 50. This edit is based on regulations from Center for Medicare & Medicaid Services and will be applied across all lines of business to ensure consistent billing practices.

How to bill bilateral procedures to ensure payment

When an ASC performs a bilateral procedure, they should bill as two procedures either as:

  • A single unit on two separate lines
  • Or with “2” in the units field on one line

For example: If you perform lavage by cannulation; maxillary sinus (antrum puncture by natural ostium) (CPT code 31020) bilaterally in one operative session, bill 31020 either on two separate lines or on one line with ''2'' in the units field.