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Billing, collection and practice management for anesthesia and pain management groups.


New CPT Modifier Rule: Add-on Codes - Bilateral (50) -vs- Right (RT) and Left (LT)

Published on February 18, 2020

As if pain management billing wasn’t complex enough, now the AMA has changed the guidelines for bilateral procedures.  Certain interventional pain management procedures will be affected by the new guidelines.  Do you know which ones? 

The AMA, in their latest CPT update, has stated that the 50 modifier should not be used for add-on codes.  That is, any code that is added on to a primary.  A good example of this is the second and third level facet joint injections. 

Under the new guidelines, the first level would be billed with a 50 (bilateral) modifier, while each additional level would be billed as two line items, a right (RT) and a left (LT).  Below is an example of a bilateral lumbar facet joint injection at three vertebral levels:






It seems simple enough, however, the evident problem with the new guidelines is, payers may not adopt them.  How then, is a provider to bill for his/her bilateral add-on services?  Unfortunately, there is no simple answer, although experienced billing companies will have strategies in place for navigating the suddenly muddied modifier waters.

Following new guidelines often results in learning opportunities.  Contacting major payers to determine their policies is one way to ensure that cashflow is uninterrupted.  Fighting denials for smaller payers is another.  The important thing for providers to remember is to document the procedure in full detail, paying careful attention to the laterality and location of each portion of the procedure.  In this way dedicated, experienced coders can apply the correct modifiers and obtain the highest reimbursement possible for your services.

Although the new guidelines can be confusing, they can be successfully traversed with little or no headache to the provider, by a billing company that goes the extra mile for clients.


By Heather E. Golfos, CPC, CANPC

Coding Department Manager