What is the CMS guideline for modifier 50?
Asked by: Sidney Medhurst | Last update: August 16, 2025Score: 5/5 (57 votes)
Can modifier 50 be billed with 2 units in medical billing?
"Modifier -50 should be used for bilateral procedures. Bilateral procedures should be listed on the claim as a single line item, with modifier -50, and a two in the units field."
What is the CMS guideline for modifier 51?
Modifier 51 comes into play only when two or more procedures are performed. It is not to be used when a procedure is performed along with an Evaluation and Management (E/M) service. There are instances where multiple procedures are performed but modifier 51 is not appropriate.
Does Medicare want 50 modifier RT and LT?
Medicare usually wants Modifier 50 and billed on 1 line, the quantity is one but you double the price. If you bill it on separate lines and do not double the price they usually pay wrong. Their manual states you can do either way, modifier 50 on one line or RT/LT.
Can we append 50 modifier for Medicare?
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.
ch # 3 - What is Modifier 50 in Medical Billing | When and where do we use Modifier 50
What is the CMS policy for modifier 50?
If the procedure is performed bilaterally, modifier 50 should be appended to the procedure code with 1 unit of service. The 150 percent payment adjustment for bilateral procedures applies.
How do you use the modifier 50 correctly?
Ultimately, proper modifier application depends on the particulars of the claim and your payor's preference. 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 I know if a CPT code needs a laterality modifier?
The -RT and -LT modifiers should be used whenever a procedure is performed on one side. For instance, when reporting CPT code 27560 (closed treatment of patellar dislocation; without anesthesia), modifier -RT or -LT should be appended if only one knee is treated.
Should modifier 50 be added to cpt code 64611?
The Medicare Physician Fee Schedule Database (MPFSDB) bilateral modifier for CPT codes 64611 and 64615 is “2.” Only one (1) unit of service should be reported for this injection. The bilateral modifier (50) should not be reported.
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.
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 CMS condition code 51?
Condition code 51, "Attestation of Unrelated Outpatient Non-diagnostic Services" is used to indicate the non-diagnostic services are clinically distinct or independent from the reason for the beneficiary's admission in order to bill them separate from the inpatient claim.
What is the CMS policy on modifier 52?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
When using a 50 modifier on a claim instead of using RT and LT on a claim, remember that?
The 50 modifier is used to indicate a bilateral procedure, meaning that a procedure was performed on both sides of the body during the same session. It does not serve as a payment modifier but helps in billing correctly for bilateral services. d. A 50 modifier does not require RT and LT to be billed.
Can you bill 64494 with modifier 50?
Bilateral procedures billed with CPT codes 64491, 64492, 64494 or 64495 should only be billed with modifier - 50, with the number of services reported as one (1).
Can modifier 50 be used in an ASC?
Providers must bill using a single line item for each procedure performed and append modifier -50 to indicate that a procedure was performed bilaterally. The bilateral procedure will be paid at 150% of the allowed amount for that procedure.
What is the CMS billing modifier 50?
Modifier FAQ -- Billing modifier 50
A: Modifier 50 is used to report bilateral procedures performed during the same operative session as a single line item.
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 CPT code 76641 with modifier 50?
CPT® code 76641 is reported for a limited unilateral breast ultrasound, and 76642 for a complete unilateral breast ultrasound. Technically it should be -50 when you do bilateral exams. However, CMS allows you to report the service with modifier 50, or on two lines with RT and LT.
Can CPT 20610 be billed with modifier 50?
The appropriate site modifier (RT or LT) must be appended to CPT code 20610 or CPT code 20611 to indicate if the service was performed unilaterally and modifier (-50) must be appended to indicate if the service was performed bilaterally.
How do you know if a modifier is used 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.
What is the correct order of CPT 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.
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.
How do you know if a CPT code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
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.