Billing for Bilateral Tests and Surgeries

Question: How do I bill for bilateral tests and surgeries?

Answer: We receive many questions about when and how to bill bilaterally. Payers provide indicators for processing a service which will help you navigate through the billing waters. They can be found in the Medicare Physician Fee Schedule Indicator Lists every Medicare administrative contractor (MAC) or your carrier should provide. You can also find how to bill in the Coding Coach: Complete Ophthalmic Reference and the Retina Coding Complete Reference Guide, books published by the Academy.

0- Unilateral service or another code for bilateral may exist. Do not append modifier -50

Example: 92018 Exam under anesthesia; complete

1- Report bilateral procedure with modifier -50

Example: 15823 Blepharoplasty

2- Code is already considered bilateral. Modifier -50 would not be applied

Example: 92250 Fundus Photography

3- Not considered bilateral. Append modifier -50 and bill quantity of 2. Used for radiological or diagnostic procedures.

Example: 76512 Ophthalmic ultrasound, diagnostic; B-scan

9- Concept of bilateral surgery does not apply

Example: 0449T XEN stent