Orthopedic Coding Alert

Question: Can we append modifier -50 to bilateral facet joint injections (64470-64476)? If yes, should we bill the bilateral charge at 150 percent of the single level?


Florida Subscriber


Answer: CPT includes a parenthetical note prior to the codes for injections 64470-64484, which states, "Codes 64470-64484 are unilateral procedures. For bilateral procedures, use modifier -50."

Most Medicare carriers prefer a single line item with modifier -50 (Bilateral procedure) appended  to the code, such as 64470-50.
 
Some commercial payers may request two line items, one with no modifier, and a second line item with modifier -50 appended. For a few other payers, you may have to submit two line items but with modifiers -RT (Right side) and -LT (Left side) and no use of modifier -50 on the claim at all.

The vast majority of payers will reimburse these bilateral claims at 150 percent of the procedure's allowable fee.
 
Insurers reason that your physician does not perform the separate "preoperative and postoperative" work or services for the second or bilateral side. As such, the 50 percent allowance for the bilateral side covers the work for the "operative" portion of the CPT code.