Medicare doesn't recognize 69210 as being a unilateral procedure, although that is the CPT code description. Therefore, they have adjusted their RVU's to reflect the payment to be for one ear, or both ears. You cannot use a 50 modifier on the code with Medicare at all, since Medicare's edits don't recognize it. Bottom line, when it comes to Medicare, whether you do one ear, or both ears, you can only bill the 69210, no 50 modifier.