Question: Can you bill 31541 bilaterally? I had heard awhile back that Medicare allows it; however, all the other insurances are denying it. Kansas Subscriber Answer: No, you may not append modifier 50 (Bilateral procedure) to 31541 (Laryngoscopy, direct,operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope). The Medicare fee schedule specifies no on bilateral for this procedure.