What is bilateral procedure?

CMS defines a bilateral service as one in which the same procedure is performed on both sides of the body during the same operative session or on the same day.

1. What is the bilateral procedure rule?
2. What is bilateral service?
3. What is a unilateral procedure?
4. How do you bill a bilateral procedure?
5. Does Medicare pay for bilateral procedures?
6. What is a bilateral surgery indicator?
7. When a bilateral procedure is performed as unilateral?
8. Where can I find Bilateral indicators?
9. What does unilateral mean in medical terms?
10. What is modifier 50 used for?
11. Does Medicare accept the 50 modifier?
12. Does Medicare pay for bilateral cerumen removal?
13. What is a staged procedure?
14. What is RT and LT modifiers?

What is the bilateral procedure rule?

Definition: A surgical procedure is considered bilateral when the same procedure is performed on both sides of the body. ... Bilateral surgical procedure codes must appear on two separate claim lines.

What is bilateral service?

Bilateral services are procedures that can be performed on both sides of the body. during the same session or on the same day by the same physician or other qualified health care professional.

What is a unilateral procedure?

What does 0 mean? If the code has an indicator of zero it is a unilateral code. Which means it will be paid per eye or site. In general, you can expect difficulties in getting paid if it is done the wrong way. If the code is assigned an indicator of 0, the procedure should in general not be performed bilaterally.

How do you bill a bilateral procedure?

Bilateral Procedures that are performed at the same session should be identified by adding modifier 50 to the appropriate CPT or HCPCS code. The procedure should be billed on one line with modifier 50 and one unit with the full charge for both procedures.

Does Medicare pay for bilateral procedures?

Medicare makes payment for bilateral procedures based on the lesser of the actual charges or 150 percent of the Medicare Physician Fee Schedule (MPFS) amount when the procedure is authorized as a bilateral procedure. This Change Request implements the 150 percent payment adjustment for bilateral procedures.

What is a bilateral surgery indicator?

The bilateral indicator "B" column shows that:

If two of the same services were performed bilaterally, the services should be billed on two separate lines with 1 unit apiece, the 50 modifier and the appropriate repeat modifier on one of the lines.

When a bilateral procedure is performed as unilateral?

When a procedure with "unilateral or bilateral" written in the description is performed unilaterally, then the CPT or HCPCS procedure code need not be reported with modifier 52 since the procedure description already indicates that the service can be performed either unilaterally or bilaterally.

Where can I find Bilateral indicators?

Use the CMS Physician Fee Schedule search to locate the bilateral indicator for the specific CPT or HCPCS code: http://www.cms.gov/apps/physician- fee-schedule/search/search-criteria.

What does unilateral mean in medical terms?

Medical Definition of unilateral

: occurring on, performed on, or affecting one side of the body or one of its parts unilateral exophthalmos.

What is modifier 50 used for?

Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).

Does Medicare accept the 50 modifier?

Ambulatory surgical centers (ASCs) and Modifier 50

ASC specialty providers don't report modifier 50. ... Medicare will allow 100% of the highest paying surgical procedure on the claim plus 50% for the other ASC-covered surgical procedures furnished in the same session.

Does Medicare pay for bilateral cerumen removal?

Finally, Medicare will not cover cerumen removal performed by an audiologist. For Medicare patients, only the physician should bill 69210 when removing cerumen on the same day as audiology testing. Some carriers might require the HCPCS code G0268.

What is a staged procedure?

We propose to define a staged procedure as a planned intervention performed after the first catheterization when it fulfills the following requirements: 1) the intent to stage is documented, provisionally or definitely, before or within 24 h after completion of the first procedure (Figure 1); 2) the lesion(s) to be ...

What is RT and LT modifiers?

DME MAC Joint Publication

The right (RT) and left (LT) modifiers must be used when billing two of same item or accessory on the same date of service and the items are being used bilaterally.