Look Twice At Your Bilateral Modifiers

Look Twice At Your Bilateral Modifiers

Medical billing bilateral modifiers give billers much headache. Not only are bilateral modifier procedures for medical billing complicated, but they are different for each insurance company. Medical billers must check and double check bilateral modifiers in order to receive payment.

It’s true, many payers will not pay claims unless they are in the format in which they require them to be. Unfortunately, each and every payer can have a different medical billing requirement for each and every procedure. Bilateral modifiers are some of the most complicated subjects for medical billers.

Modifier 50 is a bilateral modifier. For example, if someone gets eye surgery on the left eye, modifier 50 says they had the same surgery on the right eye that day as well. There are three ways in which payers can require modifier 50 to be medically billed to them. The first way is the way Medicare requires. They require medical billers to bill the CPT code once and add modifier 50 to that line.

The second way to do medical billing for bilateral modifiers is to bill the CPT code two times. In this case, medical billers would put modifier 50 on the second line.

The last method is a mixture of the other two ways. Some payers will only pay bilaterally if a CPT code is billed once, but with two units. Then modifier 50 is attached to that code.

All three of these medical billing methods are correct for some payers and incorrect for others. The sad part is that when it is incorrect, payers will not even pay. You would think they would have to know what you are trying to bill, but they still will not make payment until their specific procedures are followed.

It is a headache keeping up with all the rules for each payer. Medical billing firms can take this headache away from you. They deal with insurance companies every day and know the medical billing rules inside and out. Medical billing firms can ease your bilateral modifier problems.

View all Articles by: Melissa Clark, CCS-P