Medicare payment for bilateral surgery procedure performed

Bilateral Surgery

50 Modifier Bilateral Procedure. Modifier 50 represents that the procedure was performed bilaterally. To report bilateral services, bill the procedure with the 50 modifier and a unit of one in the days/units field or electronic equivalent.

Example: 29870-50 $1,000 Units = 1

The billed charge should reflect a bilateral procedure amount if the procedure was performed bilaterally.
Note: Please refer to your current MPFSDB to determine whether a 50 modifier may be added on the procedure code being used.

Example: The following example demonstrates pricing of bilateral services billed.

Code Allowed Bilaterally on MPFSDB (50 Modifier)Unilateral Allowed Amount $ Final Allowance$
29870-50                             Yes                     365.31 x 150% = 547.96 (bilateral)       547.96 x 80%


Example: The following example demonstrates multiple surgery pricing logic as it is applies to bilateral surgeries.

Code            Indicator 50 Modifier Unilateral Allowed Amount $  Ranking   Final Allowance $

29870-50    2           Yes   365.31 x 150% = 547.96 (bilateral) 100%             547.96 x 80%
29345-50    2           Yes    115.04 x 150% = 172.56 (bilateral) 50%             86.28 x 80%