Modifier 50 Bilateral Guidelines

Bilateral procedures and modifier 50

Appropriate claim submissions for bilateral procedures

Horizon Blue Cross Blue Shield of New Jersey requires that you identify bilateral procedures performed during the same operative session by appending modifier 50 to the appropriate five-digit Current Procedural Terminology (CPT) code (unless otherwise identified in the CPT Manual).

Please append modifier 50 to the appropriate unilateral code on a single claim line and please indicate one unit in the unit field of that claim line.

The use of modifier 50 is NOT appropriate in the following situations:

• Using modifier 50 on a bilateral procedure performed on different areas of the right and left sides of the body.
• Appending modifier 50 to a procedure code that is defined by CPT as primarily bilateral or a bilateral service.
• Appending modifier 50 to a surgical CPT code, the description of which contains the words “one” or “both.”
• Reporting bilateral procedures as two separate claim line items.

Reimbursement will be 150 percent of the fee schedule amount for the CPT code performed. Claim payment is subject to all member and group benefit limitations, conditions and exclusions.

If you have questions, please contact your Network Specialist.

CPT® is a registered trademark of the American Medical Association.