Neurology & Pain Management Coding Alert

Question: Should I use modifier -50 for bilateral facet joint injections (64470-64476)? If yes, would the fee for the bilateral be figured at 150 percent of the single level?


Georgia Subscriber

Answer: A parenthetical note preceding the para-vertebral facet joint injection codes (64470-64484) in the CPT manual states, "Codes 64470-64484 are unilateral procedures. For bilateral procedures, use modifier -50."

Precisely how you indicate the bilateral services on the claim form will depend on your payer's preference.

Most Medicare carriers follow CPT guidelines and prefer a single line item with modifier -50 (Bilateral procedure) appended to the code (for instance 64470-50). Some commercial payers may request two line items, the first with no modifier and a second line item with modifier -50 appended (for instance, 64470, 64470-50). A few payers may even ignore CPT instructions completely and advise you to submit two line items, but with modifiers -RT (Right side) and -LT (Left side) appended and no modifier -50 (for example, 64470-LT, 64470-RT).

Most payers will process bilateral claims at 150 percent of the allowable fee for a CPT code. This is because your physician is not performing the separate "preoperative and postoperative" work or services for the second or bilateral side. As such, the 50 percent allowance for the "additional" injection covers the work for the "operative" portion of the procedure only.