How do you use the modifier 50 correctly?
Asked by: Mrs. Elise Auer DVM | Last update: December 28, 2025Score: 4.5/5 (8 votes)
How to use modifier 50?
One structure, two sides, calls for modifier 50
Modifier 50 may apply when two procedures, reported using the same CPT® code, are performed on both sides of a single, symmetrical structure or organ, such as the spine, the skull or the nose.
How do you use modifiers correctly?
- Always place modifiers as close as possible to the words they modify. ...
- A modifier at the beginning of the sentence must modify the subject of the sentence. ...
- Your modifier must modify a word or phrase that is included in your sentence.
Do you bill 2 units with modifier 50?
Claims for bilateral surgical procedures should be billed on a single claim detail line with the appropriate procedure code and modifier 50 and one (1) unit of service (UOS).
How do you know which modifier goes first?
In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second. The distinction between the two is simple: you always want to list the modifiers that most directly affect the reimbursement process first.
ch # 3 - What is Modifier 50 in Medical Billing | When and where do we use Modifier 50
What is the proper sequencing of modifiers?
The proper sequencing order for modifiers is as follows: 1) pricing, 2) payment, and 3) location. Location modifier is always reported last in any coding scenario. Modifiers 26 and TC are examples of pricing modifiers while modifiers 51 and 59 are examples of payment. RT and LT are examples of location modifiers.
Does order of modifiers matter?
Answer: Yes. The payment modifier should be placed first and then any informational modifiers follow. A payment modifier example is -58, -79. These modifiers tell the payer why a surgery should be paid a certain way.
Which of the following procedures requires a modifier 50?
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).
How do you bill with modifiers?
You enter the pricing modifier directly to the right of the procedure code on the claim. Most providers use the electronic equivalent of this form to bill Medicare for professional (pro-fee) services.
How much does modifier 50 pay?
This denotes that the procedure is unilateral, as described in CPT®, and can be appropriately billed as a bilateral procedure with modifier 50 appended. Medicare will pay this procedure at 150 percent of the allowed amount, subject to the patient's deductible and coinsurance.
What's the main problem with using modifiers incorrectly?
Misplaced modifiers make the sentence awkward and sometimes unintentionally humorous.
How do I know which modifier to use?
The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).
How is modifier placed correctly?
Typically, modifiers are placed right beside the noun they're modifying. Usually, this means right before or after the noun: My calico cat is always by my side.
Is modifier 50 an anatomical modifier?
The 50 modifier identifies the service as being performed on both sides of the body. Do not report anatomical modifiers in addition to modifier 50.
How to bill for multiple procedures?
Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session. It applies to: Different procedures performed at the same session. A single procedure performed multiple times at different sites.
Do you bill 2 units with a 50 modifier?
If a procedure is authorized for the 150 percent payment adjustment for bilateral procedures (payment policy indicator 1), the procedure shall be reported on a single line item with the 50 modifier and one service unit. Whenever the 50 modifier is appended, the appropriate number of service units is one.
What is the correct order for modifiers?
In medical coding, modifiers are used to give additional information about a procedure, service, or supply, and modifiers that will have the biggest impact on reimbursement are normally sequenced first. These modifiers typically fall into one of three categories: (1) Pricing, (2) Payment, or (3) Location.
How do you correct a modifier?
Correcting Misplaced Modifiers
To correct the misplaced modifier problem, one should place single word adjectives before the word they modify and adjective phrases or clauses right after the word they modify. In the following examples, adjective phrases were placed right after the word they modify to avoid ambiguity.
Can you use a 50 modifier on an add-on code?
The AMA, in their latest CPT update, has stated that the 50 modifier should not be used for add-on codes.
What is the difference between modifier 50 and 51?
Modifier 50 Bilateral procedure describes procedures or services that take place on identical, opposing structures (e.g., shoulder joints, breasts, eyes). Use modifier 51 Multiple procedures to show that the same provider performed multiple procedures (other than E/M services) during the same session.
What is CPT code 38900 with modifier 50?
CPT 38900-50 describes intraoperative injection of dye for sentinel node identification. Modifier -50 is used for bilateral injections, and increases reimbursement by 150%, increasing the wRVU from 3.75 to 5.625.
How do you know if a modifier is used correctly?
Step 1: Identify the modifier. In most cases, dangling modifiers are placed at the start of a sentence, though they can also be found at the end. Step 2: Identify the noun or pronoun next to the modifying clause in the sentence. Step 3: Check to see if the modifier and the noun or pronoun go together logically.
What are the three common problems with modifiers?
On a sentence diagram, if a word or phrase on a diagonal line cannot be placed under its subject, or if it's placed under the wrong subject, problems will occur in one of three major ways: as dangling modifiers, as misplaced modifiers, or as squinting modifiers.
How do you avoid mistakes with modifiers?
Here are things to remember to avoid making these common modifier mistakes when writing. Keep your modifier as close as possible to what they are modifying. Always put the adjective or adverb next to the words they describe. Identify what it is modifying.