CurrentAspirus ArisePolicy N/A

-50 Bilateral Procedure Modifier

Defines when and how the -50 bilateral procedure modifier should be used for identical procedures on paired organs and describes Aspirus Health Plan Medicare Advantage payment adjustments and applicability.

Policy Summary

PayerAspirus Arise

Policy-50 Bilateral Procedure Modifier

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review DateFeb 17, 2025

Key ActionAppend -50 when an identical procedure is performed on both sides of a paired organ; do not append when the code description already indicates bilateral or when services are on different areas of the same side.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

150%standard bilateral payment adjustment when indicator = 1

100%payment basis per side when indicator = 3 (no bilateral adjustment)

Medicare Advantageproduct applicability

69436, 52290examples referenced

Bilateral Modifier Payment and Use Criteria

inv-01: Bilateral modifier payment and use criteria

Payment and applicability rules based on Medicare BILAT SURG indicator and appropriate/inappropriate uses:

ALL of the following

Submit services on one claim line with one unit of service.
Aspirus will apply multiple procedure payment logic and payment reductions for services other than the primary procedure.
When billed as bilateral (modifier -50 or reported twice on same day), base payment on the lower of: (a) total actual charge for both sides; or (b) 150% of the fee schedule amount for a single code.

ALL of the following

Policy Summary

PayerAspirus Arise

Policy-50 Bilateral Procedure Modifier

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review DateFeb 17, 2025

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Examples, Indicators, and Code Guidance

Examples and modifierCPT

69436	Tympanostomy; CPT example of bilateral use (append -50)
52290	Cystourethroscopy; example described as 'unilateral or bilateral' (do not append -50)
-50	Modifier indicating bilateral procedure

Payment adjustment indicator — Medicare BILAT SURG

Medicare BILAT SURG indicator values0, 1, 2, 3, 9

Indicator = 1 (action)150% bilateral payment adjustment applies; submit as one claim line with one unit and Aspirus applies multiple procedure payment logic for additional services.

Indicator = 3 (action)No usual bilateral adjustment; payment for each side is based on the lower of actual charge per side or 100% of the fee schedule per side.

Indicators = 0, 2, or 9 (action)Usual 150% bilateral adjustment rules do not apply; fee schedule already reflects payment — do not apply standard bilateral adjustment.

Modifier Usage and Billing Instructions

Billing Rule

Modifier -50: when to append and when not to

Append the -50 modifier when an identical procedure is performed on both sides of a paired organ. Do not append -50 when the CPT/HCPCS code description already includes the terms 'bilateral' or 'unilateral or bilateral', when services are performed on different areas of the same side, or when the Medicare BILAT SURG indicator is 0, 2, 3, or 9 (the fee schedule already reflects payment).

Appropriate: Same surgical procedure on a paired organ (e.g., CPT 69436 appended with -50).
Inappropriate: Services on different areas of the same side of the body.
Inappropriate: Codes whose description includes 'bilateral' or 'unilateral or bilateral' (e.g., CPT 52290).
Do not append -50 when Medicare BILAT SURG indicator = 0, 2, 3, or 9.

Key Terms and Indicators

-50 modifier (definition)

Definition-50 modifier: append when an identical procedure is performed on both sides of a paired organ.

Appropriate useSame surgical procedure on a paired organ (e.g., bilateral tympanostomy).

Inappropriate useDo not append when the CPT/HCPCS description already indicates 'bilateral' or 'unilateral or bilateral', or when services are on different areas of the same side.

BILAT SURG indicator — Medicare Relative Value File

Source fileMedicare Relative Value File (BILAT SURG) indicator in the RVU file determines bilateral payment behavior.

Indicator meaningsIndicator values 0,2,3,9: usual 150% adjustment does not apply; value 1: 150% bilateral adjustment applies.

Billing instructions when indicator = 1Submit as one claim line with one unit; Aspirus will apply multiple procedure payment logic for additional services.