CurrentAnthemPolicy G-07022

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

Defines Anthem/AMH Health reimbursement stance for use of modifiers LT and RT to indicate left- or right-sided procedures and how reimbursement is applied; affects providers submitting claims to the payer.

Policy Summary

PayerAnthem

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

Policy CodePolicy G-07022

Change TypeTitle updated; no material coverage changes

Effective Date7/21/2025

Next Review Date

Key ActionEnsure appropriate authorization and medical necessity per procedure and diagnosis; follow applicable contracts and CMS requirements.

SourceLink

POLICY UPDATE CHANGES

Updated policy title from Modifiers LT and RT.

100%reimbursement based on fee schedule or contracted rate

2025-07-21last approval/effective date

3policy history events listed

Coverage Criteria

LT/RT modifier coverage rules

When to use LT/RT and reimbursement implications:

Reimbursement allowed for procedure codes appended with LT and/or RT when indicating the side of the body, unless superseded by provider/state/federal/CMS contracts or requirements

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

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

Claims with LT and RT indicating procedures performed on both 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 updated; no material coverage changes

Effective Date7/21/2025

Next Review Date

Key ActionEnsure appropriate authorization and medical necessity per procedure and diagnosis; follow applicable contracts and CMS requirements.

SourceLink

On This Page

Coding and Reimbursement Notes

Side modifiersModifier

LT	Modifier indicating left side; informational; does not change reimbursement
RT	Modifier indicating right side; informational; does not change reimbursement

Reimbursement impact

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

When allowedReimbursement allowed for procedure codes appended with LT and/or RT when indicating side of body, unless superseded by provider, state, federal, or CMS contracts or requirements.

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

Provider Actions and Requirements

Prior Authorization

Authorization and Medical Necessity

Ensure appropriate authorization and medical necessity for the procedure and diagnosis before submitting claims; follow any applicable state, provider, federal, or CMS contract requirements that may supersede this policy.

Use proper billing and submission guidelines and industry-standard codes (CPT, HCPCS, revenue codes) that are fully supported in the medical record and/or office notes.
Failure to follow authorization, medical necessity, or coding/billing guidelines may result in claim rejection, denial, payment recovery/recoupment, or reimbursement adjustment.

Definitions

Bilateral

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

Usage noteDo not use LT or RT with bilateral procedures or procedure codes that include 'bilateral' or 'unilateral or bilateral' in their description.

Related ruleModifiers LT and RT do not indicate bilateral services; bilateral services follow multiple surgery or bilateral-specific coding rules.

Modifier LT

DefinitionModifier LT — Left side (used to identify procedures performed on the left side of the body).

PurposeUsed to indicate side of body for procedures, supplies, or items when reporting services.

Reimbursement noteModifier LT is informational and does not change the reimbursement amount.

Modifier RT

DefinitionModifier RT — Right side (used to identify procedures performed on the right side of the body).

PurposeUsed to indicate side of body for procedures, supplies, or items when reporting services.

Reimbursement noteModifier RT is informational and does not change the reimbursement amount.

Unilateral

DefinitionUnilateral — procedures performed on one side of the body.

Contrast with bilateralUnilateral indicates a single-side procedure; do not append LT/RT to codes already described as bilateral or 'unilateral or bilateral'.

Coding practiceStandard correct coding applies; follow provider/state/federal/CMS contract requirements which may supersede policy.

Revision History

2025-07-21review_approved_and_effectiveLatest

Policy review approved and effective; policy title updated from 'Modifiers LT and RT'.

2023-09-27review_approved

Policy review approved with no changes to policy content.

2021-05-06review_approved

Policy review approved; Reference and Research Materials and Definitions sections were updated.

2020-01-01initial_approval_and_effective

Initial approval and effective date of the policy.