Bilateral Billing Under Fire: Modifier 50

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CodeCast | Medical Billing and Coding Insights

Terry Fletcher

49 episodes

5 days ago

National Speaker and Healthcare Consultant, Auditor and Educator, Terry Fletcher CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, knows from over 25 years medical reimbursement industry experience that Coding, Billing and Compliance for physician practices and hospitals can be tough to navigate. Her CodeCast Podcast series will share insights to current rules and regulations the Medicare payer requires, along with Commercial insurance plans' rules and reimbursement challenges. Discover revenue opportunities to maximize reimbursement in your medical practice, focusing on different medical specialties and platforms each episode.

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Bilateral Billing Under Fire: Modifier 50

CodeCast | Medical Billing and Coding Insights

13 minutes 45 seconds

2 months ago

Bilateral Billing Under Fire: Modifier 50

In this episode of CodeCast, Terry dives into the complexities of billing bilateral procedures and the growing tension between Medicare guidelines and commercial payer policies. Modifier 50 is used to report procedures performed on both sides of the body during the same operative session. When billed correctly, the procedure should appear on a single claim line with the CPT or HCPCS code, modifier 50, and one unit of service. Depending on the procedure’s bilateral indicator, Medicare may apply a 150% payment adjustment.
However, commercial payers are increasingly rejecting this standard. Many are now reimbursing only one line item, effectively ignoring the bilateral nature of the procedure. This shift poses serious risks to patient care. Providers may be forced to schedule a second surgery, exposing patients to additional anesthesia and delaying medically necessary treatment.
Terry breaks down the implications of these policy changes and offers strategies for providers to advocate for proper reimbursement. Tune in to learn how to protect your patients and your practice from the fallout of this troubling trend.

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