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Look Twice Before Applying Bilateral Modifiers To Different Payors
Some payors phase out 50 modifier as "pricing modifier"

 

In a perfect world, you'd be able to bill every payor the same way, with the same rules. Unfortunately, private payors often choose their own route, which makes your life more complicated.

When you bill Medicare for a bilateral procedure using the 50 modifier, the rules are pretty simple: You bill the code once, with the 50 modifier attached. Then the Medicare carriers automatically increase your reimbursement to 150 percent of the code's usual RVUs.

But many private payors and state Medicaid programs have wildly different rules. Some of them want you to bill the code twice, on two lines, with the 50 modifier attached to the second line. Others require you to bill two units of the code on one line, and attach the 50 modifier.

Blue Cross/Blue Shield of South Carolina recently wrote to providers to say that it would no longer recognize the 50 modifier with a single unit on a single line, according to Hidy Borden, senior reimbursement analyst with the Medical University of South Carolina in Charleston. Instead, providers must either use two lines, or two units on a single line.

To add to the confusion, the change applied to some of the Blue Cross health plans, but not others. And the Blues rep claimed the change also applied to South Carolina Medicare, which Blue Cross oversees as Palmetto GBA. But so far no sign of the change has appeared on Palmetto's Web site, and this would be a dramatic departure from other Part B Medicare carriers' practices.

The reason for the change? The Blue Cross plan no longer recognizes the 50 modifier as a "pricing modifier." In other words, the 50 modifier would no longer automatically trigger a change in reimbursement by itself, unless there were multiple units.




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