What is a bilateral indicator?

The bilateral indicator “B” column shows that: If two of the same services were performed bilaterally, the services should be billed on two separate lines with 1 unit apiece, the 50 modifier and the appropriate repeat modifier on one of the lines.

What is considered a bilateral procedure?

CMS defines a bilateral service as one in which the same procedure is performed on both sides of the body during the same operative session or on the same day.

How do I know if a CPT code is bilateral?

What does 2 mean? If the code has an indicator of two, it is a bilateral procedure code. You would not need to add a modifier 50 because the code is already bilateral. A code with this indicator lets the insurance company know that both sides were done.

What modifier means bilateral?

modifier 50

The modifier 50 is defined as a bilateral procedure performed on both sides of the body.

What does inherently bilateral mean?

An indicator of 2 designates the procedure as inherently bilateral. Therefore, the procedure itself indicates a bilateral procedure and already includes payment for both sides.

What is bilateral service?

Bilateral services are procedures that can be performed on both sides of the body. during the same session or on the same day by the same physician or other qualified health care professional.

How do you bill bilateral procedures for UnitedHealthcare?

Q: What is the most appropriate way for a physician or other health care professional to bill UnitedHealthcare for a Bilateral Procedure? A: The procedure should be billed on one line with a modifier 50 and one unit with the full charge for both procedures.

How are bilateral procedures paid?

Medicare makes payment for bilateral procedures based on the lesser of the actual charges or 150 percent of the Medicare Physician Fee Schedule (MPFS) amount when the procedure is authorized as a bilateral procedure. This Change Request implements the 150 percent payment adjustment for bilateral procedures.

How do you bill bilateral 20610?

Place the CPT code 20610 in item 24D. If the drug was administered bilaterally, a -50 modifier should be used with 20610.

What does unilateral procedure mean?

If a procedure code indicates it’s a unilateral procedure and the service is conducted on the identical anatomic sites on opposite sides of the body, the appropriate way to bill varies.

Does Medicare accept the 50 modifier?

Modifier 50 – Correct Usage

Appropriate usage includes: Use modifier 50 when performing a bilateral procedure during one session and the Medicare Physician Fee Schedule Relative Value File (MPFSRVF), also known at the Medicare Physician Fee Schedule Database (MPFSDB) BILAT SURG indicator is 1 or 3.

Does Medicare require RT and LT modifiers?

Several DME MAC LCD-related Policy Articles require the use of the RT and LT modifiers for certain HCPCS codes. The right (RT) and left (LT) modifiers must be used when billing two of same item or accessory on the same date of service and the items are being used bilaterally.

How do you bill CPT 69210 bilateral?

For bilateral impacted cerumen removal, report code 69210 with modifier 50, Bilateral Procedure, appended.

Does Medicare cover 69210?

Medicare cannot reimburse audiologists for CPT code 69210 or HCPCS code G0268 under any circumstances.

How Much Does Medicare pay for 69210?


CPT Code 69210 Removal impacted cerumen (separate procedure), 1 or both ears
Average Medicare Reimbursement Per Procedure** $33.88
Break Even (Procedures) 3.33

Is 69210 a bilateral code?

The descriptors for codes 69209 & 69210 indicate that they are unilateral codes. For bilateral impacted cerumen removal, report these codes with modifier 50, Bilateral Procedure, appended. Note: Medicare does not allow the use of modifier 50 for impacted cerumen removal.

How do I get my 69210 payment?

A.An E/M code may be eligible for reimbursement in addition to code 69210 if all of the following criteria are met: The patient’s condition required a significantly, separately identifiable E/M service above and beyond the usual pre-service and post-service care associated with the removal of the impacted wax.

How do you bill bilateral ear irrigation?

CPT® states, “For bilateral procedure, report 69210 with modifier 50.” Medicare will pay the same amount for 69210 whether it is performed on one ear or two, even though the CPT® descriptor stipulates it is unilateral.

Who can perform 69210?

Historically, many payers have required a physician to provide the service. Some payers continue to observe this restriction, while others may allow an NPP (such as nurse practitioner, physician assistant, or clinical nurse specialist) to perform and report 69210.

Is 69210 a surgical procedure?

The Current Procedural Terminology (CPT®) code 69210 as maintained by American Medical Association, is a medical procedural code under the range – Removal Procedures on the External Ear.

What is a 99213 office visit?

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making.

What is the difference between 69210 and 69209?

Like CPT 69210, (removal of impacted cerumen requiring instrumentation, unilateral) 69209 requires that a physician or qualified healthcare professional make the decision to irrigate/lavage. However, unlike 69210, 69209 allows removal to be carried out by clinical staff.

Is 69209 a bilateral procedure?

Both 69209 and 69210 are unilateral procedures. For removal of impacted earwax from both ears, append modifier 50 Bilateral procedure to the appropriate code. In the example above of the 7-year-old child, if irrigation occurred in both ears, appropriate coding is 69209-50.

Can you code 69209 and 69210 together?

You may not bill CPT code 69209 with CPT code 69210, “removal impacted cerumen requiring instrumentation, unilateral,” for the same ear. However, CPT codes 69209 and 69210 can be billed for the same encounter if impacted cerumen is removed from one ear using instrumentation and from the other ear using lavage.