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Bilateral Billing Under Fire: Modifier 50

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Manage episode 502543243 series 2490675
Content provided by Terry Fletcher. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Terry Fletcher or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://podcastplayer.com/legal.

In this episode of CodeCast, Terry dives into the complexities of billing bilateral procedures and the growing tension between Medicare guidelines and commercial payer policies. Modifier 50 is used to report procedures performed on both sides of the body during the same operative session. When billed correctly, the procedure should appear on a single claim line with the CPT or HCPCS code, modifier 50, and one unit of service. Depending on the procedure’s bilateral indicator, Medicare may apply a 150% payment adjustment.

However, commercial payers are increasingly rejecting this standard. Many are now reimbursing only one line item, effectively ignoring the bilateral nature of the procedure. This shift poses serious risks to patient care. Providers may be forced to schedule a second surgery, exposing patients to additional anesthesia and delaying medically necessary treatment.

Terry breaks down the implications of these policy changes and offers strategies for providers to advocate for proper reimbursement. Tune in to learn how to protect your patients and your practice from the fallout of this troubling trend.

Subscribe and Listen

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post Bilateral Billing Under Fire: Modifier 50 appeared first on Terry Fletcher Consulting, Inc..

  continue reading

85 episodes

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iconShare
 
Manage episode 502543243 series 2490675
Content provided by Terry Fletcher. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Terry Fletcher or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://podcastplayer.com/legal.

In this episode of CodeCast, Terry dives into the complexities of billing bilateral procedures and the growing tension between Medicare guidelines and commercial payer policies. Modifier 50 is used to report procedures performed on both sides of the body during the same operative session. When billed correctly, the procedure should appear on a single claim line with the CPT or HCPCS code, modifier 50, and one unit of service. Depending on the procedure’s bilateral indicator, Medicare may apply a 150% payment adjustment.

However, commercial payers are increasingly rejecting this standard. Many are now reimbursing only one line item, effectively ignoring the bilateral nature of the procedure. This shift poses serious risks to patient care. Providers may be forced to schedule a second surgery, exposing patients to additional anesthesia and delaying medically necessary treatment.

Terry breaks down the implications of these policy changes and offers strategies for providers to advocate for proper reimbursement. Tune in to learn how to protect your patients and your practice from the fallout of this troubling trend.

Subscribe and Listen

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post Bilateral Billing Under Fire: Modifier 50 appeared first on Terry Fletcher Consulting, Inc..

  continue reading

85 episodes

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