tci Part B Insider - 2005 Issue 31

MODIFIERS: Look Twice Before Applying Bilateral Modifiers To Different Payors

Some payors phase out 50 modifier as "pricing modifier"In a perfect world, you'd be able to bill every payor the same way, with the same rules. Unfortunately, private payors often choose their own route, which makes your life more complicated.When you bill Medicare for a bilateral procedure using the 50 modifier, the rules are pretty simple: You bill the code once, with the 50 modifier attached. Then the Medicare carriers automatically increase your reimbursement to 150 percent of the code's usual RVUs. But many private payors and state Medicaid programs have wildly different rules. Some of them want...

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