Reporting Unilateral or Bilateral Codes

December 18th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Categories:   Modifiers   Billing  
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Generally, Audiology tests are coded as if they were performed on both ears, if the testing was performed only on one ear, you are required to append a modifier to acknowledge there was a reduced service or a unilateral assessment, using modifier 52 - Reduced Services.

(Be sure to read the code descriptor to verify you are coding for a unilateral or bilateral procedure). Always refer to the Payment rules to determine Bilateral Payment rules when using Modifier 50 as well: For example, if a procedure has a payment indicator of "0", do not use Modifier 50 - Bilateral surgery payment rules do not apply. If a code has a payment indicator of "1" then Bilateral surgery payment rules do apply and reimbursement is at 150%.

The use of HCPCS Level II Modifiers - RT and LT, should only be used when Bilateral Surgery rules DO NOT apply according to CMS.

Codes with an indicator of "0" can never be billed with modifier 50.

Codes with an indicator of "3" can be billed with 50 or LT/RT. These services are generally radiologic and other diagnostic services. (When these services are performed bilaterally most payers want them billed with LT/RT)

Codes that have an indicator of "3" that are billed bilaterally receive reimbursement for each code billed.

Codes that have an indicator of "0" that are billed using LT/RT receive reimbursement for a single code.

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