Billing > Facility Billing

Billing bilateral procedures in an ASC

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trisha426:
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

Michele:
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.

trisha426:
No, I am billing strictly for the facility fees with SG modifier stating its an ASC and modifier 50.

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

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