10/01/2021

Billing for Bilateral Injections and Using Modifier 50 and 59 for 20600

Two part question: 1. We are not always sure if we should bill bilateral injections as LT and RT or use the 50 modifier? 2. In one case we used the 50 modifier for 20600, can we use a 59 modifier also on the same line, as we need it for the injections?

For a majority of insurances, bilateral services should be reported on separate line items with the appropriate site modifiers and applicable diagnosis codes. Unless a denial is received from an insurance for one or both services due to frequency, where it would be necessary to resubmit a corrected claim with one line item representing both services, modifier -50 should not be used. If a claim needs to be billed with modifier -50, the charge line should be submitted with one unit of service with the fee doubled with use of modifier. Below is a list of the known New York payers that require the use of modifier -50 for bilateral services:

• Blue Cross (procedures and x-rays)
• Medicare (procedures only)
• Oxford (procedures only)
• United Healthcare (procedures only)
• United Healthcare Community Plan (procedures only)

Modifier -59 can be used with a bilateral service if the lesser service should be reimbursed or unbundled from a more comprehensive service that was performed bilaterally. As long as the coding submitted supports separate payment, there should be no issues. If only one procedure was performed bilaterally, modifier -59 should not be used on the charge with modifier -50.