CurrentAnthemPolicy G-06010

Modifier 50 and 51: Multiple and Bilateral Surgery reimbursement

Defines Anthem's reimbursement rules for multiple and bilateral surgical procedures, including billing modifiers and payment reductions, for professional and facility providers where applicable.

Policy Summary

PayerAnthem

PolicyModifier 50 and 51: Multiple and Bilateral Surgery reimbursement

Policy CodePolicy G-06010

Change TypeNo material changes (12/18/2025 review)

Effective DateDec 18, 2025

Next Review Date

Key ActionBill professional claims with modifier 51 for multiple procedures and report bilateral procedures with modifier 50 when using a unilateral code.

SourceLink

POLICY UPDATE CHANGES

12/18/2025 - Review approved and effective: no changes

08/28/2023 - Review approved and effective: updated policy title to include Modifiers 50 and 51, and removed Professional and Facility Reimbursement

100%payment for highest-valued procedure

50%payment for 2nd through 5th procedures

50%*payment for 6th and additional procedures

150%reimbursement with modifier 50

Multiple and Bilateral Surgery reimbursement criteria

Reimbursement rules and billing requirements for multiple and bilateral surgeries.

Reimbursement follows the multiple and bilateral surgery rules below.

Multiple Surgery Payment Reductions

Pay 100% of the fee schedule or contracted/negotiated rate for the highest-valued procedure.
Pay 50% for the secondary through the fifth procedures.
Pay 50% for the sixth and additional procedures only if determined to be medically necessary through clinical review.
Clinical review must document medical necessity for payment of sixth and additional procedures.

Policy Summary

PayerAnthem

PolicyModifier 50 and 51: Multiple and Bilateral Surgery reimbursement

Policy CodePolicy G-06010

Change TypeNo material changes (12/18/2025 review)

Effective DateDec 18, 2025

Next Review Date

Key ActionBill professional claims with modifier 51 for multiple procedures and report bilateral procedures with modifier 50 when using a unilateral code.

SourceLink

On This Page

Authorization, Medical Necessity, and Billing Requirements

Prior Authorization

Authorization and medical necessity

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 and ensure services are fully supported in the medical record. Failure to follow appropriate coding/billing guidelines or current reimbursement policies may result in claim rejection, denial, recovery/recoupment, or adjustment of reimbursement.

Use industry-standard CPT, HCPCS, and/or revenue codes supported by the medical record or office notes.
Verify member benefit coverage and any state- or contract-specific requirements prior to billing.

Billing Rule

Modifier billing requirements

Professional provider claims for applicable surgical procedures must be billed with modifier 51 to denote multiple procedures; facility claims should not be billed with modifier 51. Bilateral procedures reported with a unilateral code must be submitted on a single line with modifier 50 for both professional and facility claims.

Do not append LT, RT, or 50 when the code terminology or code is inherently bilateral; such codes are reimbursed at 100%.
Claims billed without the correct modifier for multiple or bilateral procedures may not be eligible for reimbursement and are subject to multiple procedure reductions when applicable.

Key Definitions and Modifier Guidance

Bilateral

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

ReportingBilateral procedures using a unilateral code should be reported with modifier 50 on a single line for professional and facility claims (see billing rules).

Inherently bilateral codesIf code terminology is inherently bilateral, do not append LT/RT/50; reimburse at 100%.

Modifier 50

MeaningModifier 50 indicates a bilateral procedure (Bilateral Procedure).

Usage noteAdd modifier 50 to the appropriate 5-digit code when procedures are performed bilaterally, unless code listing specifies otherwise.

Do not appendThis modifier should not be appended to designated 'add-on' codes.

Modifier 51

MeaningModifier 51 indicates additional procedures performed at the same session by the same individual (Multiple Procedures).

Billing requirementProfessional provider claims for applicable surgical procedures must be billed with modifier 51 to denote multiple procedures; facility claims should not be billed with modifier 51.

Do not appendThis modifier should not be appended to designated 'add-on' codes.

Modifier LT

MeaningModifier LT identifies procedures performed on the left side of the body.

Use caseAppend LT to procedure codes to designate left-side procedures when bilateral or side-specific reporting is required.

Relation to bilateral reportingDo not substitute LT/RT for modifier 50 when the code is intended to be reported bilaterally with modifier 50 per policy guidance.

Modifier RT

MeaningModifier RT identifies procedures performed on the right side of the body.

Use caseAppend RT to procedure codes to designate right-side procedures when bilateral or side-specific reporting is required.

Relation to bilateral reportingDo not substitute LT/RT for modifier 50 when the code is intended to be reported bilaterally with modifier 50 per policy guidance.

Multiple Surgeries

DefinitionMultiple surgeries are distinct surgical procedures performed by a provider on the same patient during the same operative session.

Reimbursement approachPay 100% for the highest-valued procedure; apply multiple procedure payment reductions to additional procedures as specified by policy.

BillingReport additional procedures by appending modifier 51 on professional claims; facility claims should not include modifier 51.

OpenPayer

Modifier 50 and 51: Multiple and Bilateral Surgery reimbursement

Multiple and Bilateral Surgery reimbursement criteria

Modifiers and Payment Reduction

Authorization, Medical Necessity, and Billing Requirements

Key Definitions and Modifier Guidance

Modifier 50	Bilateral Procedure
Modifier 51	Multiple Procedures
Modifier LT	Left side
Modifier RT	Right side