We would like to offer providers a few reminders about billing for bilateral procedures. Harvard Pilgrim utilizes the bilateral indicator in the CMS National Physician Fee Schedule Relative Value File to determine which procedures can be billed bilaterally.
Procedures with a bilateral indicator of 0 should not be reported with modifier 50, LT, or RT, as the concept of “bilateral” does not apply to these procedures (due to physiological reasons, the fact that the description of the code indicates that it is a bilateral procedure by definition, the fact that the procedure is not commonly performed bilaterally, etc.). Some examples of CPT codes that should not be billed with a bilateral modifier are 71020, 93010, and 64420.
Procedures with a bilateral indicator of 1 are valid for bilateral billing with modifier 50. If a procedure is performed bilaterally, modifier 50 should be appended to the procedure code with 1 unit of service; when modifier 50 applies, please do not use modifiers RT and LT. Harvard Pilgrim reimburses bilateral services performed on both sides of the body during the same session or on the same day at 150% of the fee schedule allowed amount.
For more information, please refer to the Bilateral Services and CPT Modifier 50 Payment Policy.