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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

August 2015

Bilateral Reimbursement

Beginning Nov. 1, 2015, Harvard Pilgrim will be updating our systems to recognize the Centers for Medicare and Medicaid Services’ (CMS) bilateral status indicators.
CPT or HCPCS codes that are bilateral in their intent or with “bilateral” written in their description should not be reported with the bilateral modifier 50 or the modifiers LT and RT.
When submitting claims, please keep in mind that the appropriate billing method for these services is to bill the procedure code on a single line without a modifier such as 50, LT or RT, and with one unit of service. To report a unilateral service, however, append the modifier 52 (reduced service) and the LT or RT modifier.

Update to Vision Services Payment Policy

In a review of claims, Harvard Pilgrim found that vision services claims were the most likely to have a modifier 50, LT, and RT inaccurately applied. Therefore, we have updated the Vision Services Payment Policy to provide greater clarity on bilateral reimbursement.

The updated Vision Services Payment Policy provides examples of bilateral vision codes that will not be reimbursed when modifier 50, LT, or RT are appended. For more information, please refer to the updated Vision Services Payment Policy.

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Bilateral Reimbursement

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator