By checking the fee schedule’s BILAT SURG column, you can determine whether Medicare will reimburse for a given code with modifier 50 (Bilateral surgery), when appropriate.
Quick explanation: You should apply modifier 50 only when the BILAT SURG column contains a “1″ for the chosen code.
A “0” indicator means that you should not apply modifier 50 (or modifiers LT, Left side; and RT, Right side). In these cases, a bilateral adjustment is inappropriate because of physiology or anatomy, or because the code description specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure, according to CMS guidelines.
Example: Code 51102 (Aspiration of bladder; with insertion of suprapubic catheter) contains a 0 in the BILAT SURG column. Because the...
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