Beginning December 8, 2024, and for services provided on or after January 1, 2020, new guidelines will apply to billing for bilateral surgical procedures with the bilateral RVU indicator of “1” for bilateral procedures (modifier 50). See the Centers for Medicare & Medicaid Services PFS Relative Value Files webpage.
*Reference Column T – BILAT SURG
Codes with the modifier 50 indicator of “1,” are valid for bilateral billing claim submission. With the exception of CPT codes inherently bilateral by definition, Medicaid requires practitioners to report procedures performed bilaterally, left and right, same procedure, same date of service, on one claim line with modifier 50 appended to the code (e.g., xxxxx-50, billed with 1 unit). Failure to report bilateral procedures in this way may result in incorrect processing or denial of claims.
Reporting these bilateral-indicator-1 procedures with either LT or RT and 1 unit of service is appropriate only if the procedure is being performed unilaterally. If the procedure is performed bilaterally, modifier 50 must be appended to the procedure code with 1 unit of service.
When a surgery is performed bilaterally, on the left and right, with the same procedure code and date of service, providers should submit a single claim line billed with the bilateral procedure modifier 50.
The following new edits and EOBs are being implemented to support these changes.
