CurrentAnthemPolicy G-07022

Modifiers LT and RT: Left-Side and Right-Side Procedures

Defines Anthem Blue Cross and Blue Shield Medicaid Ohio reimbursement stance for using LT and RT modifiers to denote left or right side procedures and explains billing and reimbursement implications for providers submitting claims.

Policy Summary

PayerAnthem

PolicyModifiers LT and RT: Left-Side and Right-Side Procedures

Policy CodePolicy G-07022

Change TypeTitle update and routine review entries (no material changes)

Effective Date7/21/2025

Next Review Date

Key ActionClaims using LT/RT must follow proper billing and submission guidelines and meet authorization and medical necessity; improper use may lead to denial, rejection, or recoupment.

SourceLink

POLICY UPDATE CHANGES

Updated policy title from Modifiers LT and RT.

Review approved on 09/27/2023 with no changes.

Initial approval and effective date recorded as 02/01/2023.

100%Reimbursement based on

3Policy history entries

2Modifier definitions

Modifier Coverage Criteria

LT/RT Modifier Coverage Criteria

Covered when ALL of the following are met:

ALL of the following

Modifiers LT and/or RT are allowed and accepted to indicate the side of the body for which the item, supply, or procedure will be used.
Modifiers LT and RT are informational modifiers and do not increase or decrease reimbursement; reimbursement is based on 100% of the fee schedule or contracted/negotiated rate.
Do not append LT or RT to procedure codes that are described as bilateral or for bilateral procedures; LT/RT do not indicate bilateral services.
Claims submitted with LT and RT indicating procedures on both the left and right sides are subject to multiple surgery rules.

Policy Summary

PayerAnthem

PolicyModifiers LT and RT: Left-Side and Right-Side Procedures

Policy CodePolicy G-07022

Change TypeTitle update and routine review entries (no material changes)

Effective Date7/21/2025

Next Review Date

Key ActionClaims using LT/RT must follow proper billing and submission guidelines and meet authorization and medical necessity; improper use may lead to denial, rejection, or recoupment.

SourceLink

On This Page

Coding and Reimbursement Details

Side-specific ModifiersModifier

LT	Modifier indicating left side
RT	Modifier indicating right side

Reimbursement impact

Reimbursement impactModifiers LT and RT are informational and do not increase or decrease reimbursement; reimbursement is based on 100% of the fee schedule or contracted/negotiated rate.

AllowanceProcedure codes appended with LT and/or RT are allowed when indicating side of body, unless contracts or requirements indicate otherwise.

Basis for paymentReimbursement is based on the fee schedule or contracted/negotiated rate (100%).

Bilateral billing rule

Bilateral billing ruleDo not use LT/RT for bilateral procedures or with procedure codes that include 'bilateral' or 'unilateral or bilateral' in their description; LT/RT do not indicate bilateral services.

Multiple surgeryClaims indicating procedures on both sides with LT and RT are subject to multiple surgery rules.

Contract exceptionsDo not append LT/RT when provider, state, federal, or CMS contracts/requirements indicate otherwise.

Billing, Authorization, and Submission Guidance

Billing Rule

Billing, Authorization, and Medical Necessity Requirements for LT/RT Modifiers

Ensure claims using modifier LT or RT follow proper billing and submission guidelines and that the services meet authorization and medical necessity requirements. Use industry-standard CPT, HCPCS, and/or revenue codes that are fully supported in the medical record; failure to follow coding/billing guidelines may result in claim rejection, denial, or recovery/recoupment of payment.

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis and the member's state of residence.
Use proper billing and submission guidelines, including industry-standard CPT, HCPCS, and/or revenue codes, fully supported in the medical record or office notes.
Improper coding or billing may result in claim rejection, denial, or recovery/recoupment of claim payment.

Definitions

Bilateral

DefinitionBilateral procedures are performed on both sides of the body during the same operative session.

ImplicationBilateral procedures should not be reported using LT/RT modifiers as those modifiers do not indicate bilateral services.

Billing noteClaims for bilateral procedures follow applicable multiple surgery and billing rules rather than LT/RT modifier reporting.

Modifier LT

DefinitionModifier LT denotes the left side and is used to identify procedures performed on the left side of the body.

Use limitationDo not use LT to indicate bilateral procedures; LT is informational and does not change reimbursement.

Billing guidanceAppend LT when appropriate to indicate side of body per coding guidelines, unless contracts/state/CMS require otherwise.

Modifier RT

DefinitionModifier RT denotes the right side and is used to identify procedures performed on the right side of the body.

Use limitationDo not use RT to indicate bilateral procedures; RT is informational and does not change reimbursement.

Billing guidanceAppend RT when appropriate to indicate side of body per coding guidelines, unless contracts/state/CMS require otherwise.

Unilateral

DefinitionUnilateral procedures are procedures performed on one side of the body.

Contrast with bilateralUnilateral indicates a single-side procedure; LT/RT may be used to specify which side when applicable.

Coding noteDo not append LT/RT to codes already described as bilateral; follow code description and billing rules.

OpenPayer

Modifiers LT and RT: Left-Side and Right-Side Procedures

Modifier Coverage Criteria

Coding and Reimbursement Details

Billing, Authorization, and Submission Guidance

Definitions

Policy Revision History