Billing > Facility Billing

Billing bilateral procedures in an ASC


I recently watched a Medicare webinar that states ASC claims can not use a modifier 50 for a bilateral procedure. Does anyone know if this is followed by all insurance companies? I recently took over for a biller who sends claims for breast reductions 19318 with modifier 50 to BCBS and it pays, but I do not want to continue doing something incorrectly. I have also played around with the same procedure 19318 on 2 lines with a LT, RT modifier and 1 line gets denied. Any help will be appreciated. Thank you

Are you billing for the ASC or the professional fees?   It is true that Medicare does not recognize the 50 modifier for ASCs because they pay 100% for the procedure whether it's bilateral or not.  If you are billing for the professional fees you would still use the 50 modifier.

No, I am billing strictly for the facility fees with SG modifier stating its an ASC and modifier 50.

Then according to the information I am seeing, you would not use the 50 modifier.


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