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Whether you use a -50 modifier or -LT/RT modifiers is dependant on the insurance. Look at previous claims from this insurance, or make a call, or file a claim and wait for the outcome. If it is Medicare, then I believe in an ASC setting they will want -LT/RT. UHC will generally also want -LT/RT. BCBS sometimes want -50, but sometimes wants units (yes, for a bilateral!). Other insurances are weirder, some wanting the first line as -LT, and the second line as -50 -RT. So check the particular insurance.