Modifier 50

Modifier 50 – Bilateral procedure

Modifier 50 should be appended to indicate the procedures performed on both the sides (Right and left) on the same day/session.

• If bilateral procedure code not available, then we should report appropriate unilateral code by appending modifier 50 indicating both the sides procedure performed on same day/session.

Example: Endovascular repair:

When endovascular repair of iliac artery by deployment of an ilio-illiac tube endograft, we report the claim with procedure code 34707 or 34708, when performed unilateral.

If Bilateral performed on the same day/session, then we don’t have separate code to report as bilateral performed for above procedures.

In that case we report the above procedure by appending modifier 50 to indicate bilateral procedure performed on the same day/session.

34707 with modifier 50

Or

34708 with modifier 50

• If bilateral code available, which indicates both the sides procedures performed. Then we need to report only that appropriate bilateral procedure code and should never append modifier 50 to it.

Example: CPT 50300 – Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral.

In the above case we should not report the CPT 50300 with modifier 50, because the procedure code already indicates it’s bilateral.

Important Note: It is incorrect to append RT and LT modifier in addition with the modifier 50, because modifier 50 already indicates both right and left side’s (bilateral) procedure performed at the same operative session.

Usage of Modifier 50 with examples:

Example 1:

A baby born at 32 weeks undertook five photocoagulation health care services to both the eyes due to retinopathy of prematurity at six months of age. Provider used an operating microscope during these procedures. These services occurred once per day for a defined treatment period of five days.

In this examples procedure is performed for both the eyes, hence we report the claim with modifier 50 to indicate both side of eyes procedure performed.

67229 with modifier 50

Example 2:

A patient with 13 years old with chronic otitis media was taken to surgery and placed under general anesthesia. Dr. Chris performed a bilateral tympanostomy with the insertion of ventilating tubes.

In this example procedure performed bilaterally, hence we report the claim with modifier 50.

69436 with modifier 50

Example 3:

A patient has numerous calculi of the right and left ureter and this patient has Medicare insurance. A laparoscopic surgical ureter lithotomy was done and 2 calculi are taken from the left side ureter and 3 from the right ureter.

Here the same procedures performed on right and left side ureter, hence we report the claim with modifier 50 to indicate both the sides procedure performed.

50945 with modifier 50

Example 4:

Provider performed Dilation of lacrimal punctum bilaterally for patient George on 12/10/2019, how the procedure codes are reported?

For the patient George we report the claim with procedure code 68801 for Lacrimal punctum. Since services performed bilaterally, claim should be reported with modifier 50 as we don’t have separate bilateral procedure to indicate services performed bilaterally.

68801 with modifier 50 should be reported for the DOS 12/10/2019.