June 2010
Appropriate use of Modifiers -50 and -51
Functional modifiers, such as Modifier -50 Bilateral Procedure and Modifier -51 Multiple Procedures provide additional information that affects reimbursement. Assigning the appropriate modifier ensures your claims are processed and paid accurately. We have identified a high volume of claims improperly appending Modifier -50 and/or Modifier -51 to several procedures.
The following examples illustrate appropriate and inappropriate use of these modifiers:
Modifier -50 Bilateral Procedure is appended to a procedure code to indicate that a bilateral procedure was performed during the same operative session, unless there is a more appropriate code available to reflect the bilateral nature of the service. Bilateral procedures should be billed with one unit of service.
For example, CPT 30140 Submucous resection inferior turbinate, partial or complete, any method:
- If performed on only one turbinate, report CPT 30140 with no modifier.
- If performed on the left and right turbinates, report CPT 30140-50 on one line of the claim form, with a total of one unit. (View our Working with Modifiers workshop for Ambulatory Surgical Center billing exception.)
Note: if the code description indicates a bilateral procedure, reporting Modifier -50 is not appropriate. We use CMS' Bilateral Procedure Indicators to determine if a code is valid for use with Modifier -50.
Modifier -51 Multiple Procedures is appended to procedures or services (other than E&M services) that are performed in addition to the primary procedure or service. Modifier -51 should not be used in place of Modifier -50 and should not be used with an "add-on" code.
Modifiers -50 and -51 together are necessary when multiple procedures are performed on bilateral sites. If a bilateral procedure is performed as a second or third procedure, use Modifier -50 first followed by Modifier -51.
For example, if while performing a septoplasty (CPT 30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft), the physician also performed a bilateral resection of the turbinates (CPT 30140), the claim would be coded as follows:
- Line 1 - CPT 30520
- Line 2 - CPT 30140-50-51
Resources
- Review our recently added modifier information.
- View our revised Working with Modifiers workshop.