CurrentUnitedHealthcarePolicy 2026R0023B

Bilateral procedure coding and reimbursement (CMS 1500)

Defines UnitedHealthcare's billing and reimbursement rules for procedures performed bilaterally and billed on CMS-1500 forms (including electronic equivalent) for Commercial and Individual Exchange plans; applies to all physicians and other qualified health care professionals.

Policy Summary

PayerUnitedHealthcare

PolicyBilateral procedure coding and reimbursement (CMS 1500)

Policy CodePolicy 2026R0023B

Change TypeRevisedClarifiedAdded

Effective Date

Next Review Date

Key ActionDo not report modifier 50 on CPT/HCPCS codes unless the code is on UnitedHealthcare's Bilateral Eligible Procedures Policy List; modifier 50 on ineligible codes will not be reimbursed.

SourceLink

POLICY UPDATE CHANGES

UnitedHealthcare will apply CMS's payment adjustment methodology to bilateral eligible procedures with a bilateral indicator of "1" regardless of the Multiple Procedure Indicator.

CPT/HCPCS codes that include 'bilateral' or 'unilateral or bilateral' in their description are not eligible for modifier 50 and have special billing rules (may require modifier 52 when performed unilaterally).

A Bilateral Eligible Procedures Policy List is maintained based on CMS NPFS bilateral status indicators and identifies codes eligible for modifier 50.

150%reimbursement for indicator '1'

200%reimbursement for indicator '3'

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eligible codes source

Multiplelist update history

Bilateral Procedure Coverage Criteria

Bilateral procedure coverage criteria

UnitedHealthcare allows bilateral billing (modifier 50) only for codes on its Bilateral Eligible Procedures Policy List (derived from CMS NPFS bilateral indicators '1' or '3') and applies specific payment adjustments.

If a CPT/HCPCS code has NPFS bilateral indicator '1' or '3' and is on UnitedHealthcare's Bilateral Eligible Procedures Policy List, modifier 50 is allowed; otherwise modifier 50 is not reimbursable.

When a CPT or HCPCS code is reported with modifier 50 and the code is not listed on the UnitedHealthcare Bilateral Eligible Procedures Policy List, the code will not be reimbursed.

Preferred billing for bilateral procedures: bill one line with modifier 50 and one unit with the full charge for both procedures when the code is eligible.

For codes with NPFS bilateral indicator '1' reported bilaterally with modifier 50 (or on separate lines with modifiers LT and RT for the same structure), UnitedHealthcare reimburses at 150% of the single allowable amount (one side 100% and the other side 50%), not to exceed billed charges.

For codes with NPFS bilateral indicator '3' reported with modifier 50 and not subject to Multiple Procedure or MPPR reductions, UnitedHealthcare reimburses 100% of the allowable amount for each side for a sum of 200% of the allowable amount, not to exceed billed charges.

When other reducible procedure codes are reported on the same date of service, an additional multiple procedure or imaging MPPR may or may not be applied to the line paid at 100% depending on ranking; refer to UnitedHealthcare Multiple Procedure and MPPR policies.

CPT/HCPCS codes that include 'bilateral' or 'unilateral or bilateral' in the description are not eligible for modifier 50 and are excluded from the Bilateral Eligible Procedures Policy List.

When a CPT/HCPCS procedure code exists for both a unilateral and a bilateral procedure, select the code that best represents the service; if only a bilateral description exists and the service is performed unilaterally, report the code with modifier 52 for reduced services.

When a procedure with 'unilateral or bilateral' in the description is performed unilaterally, reporting modifier 52 is not required; LT/RT modifiers are informational only in that scenario.

Multiple sites beyond bilateral: If bilateral services are performed at multiple distinct sites beyond bilateral, report additional units with modifier 59 (or XS) with supporting medical record documentation.

Coding and Reimbursement Rules

Bilateral eligible per NPFSmixedCovered

Codes in NPFS with bilateral indicator '1' or '3' are considered bilateral eligible per UnitedHealthcare; lists maintained as attachments.

Codes inherently bilateralmixedNot Covered

CPT or HCPCS codes with 'bilateral' or 'unilateral or bilateral' written in the description are not eligible for modifier 50 and have special reporting rules (may require modifier 52 when performed unilaterally); LT/RT are informational only.

inv-04: reimbursement adjustment for indicator '1'

Reimbursement adjustmentFor bilateral indicator '1': UnitedHealthcare reimburses at 150% of the single allowable amount (one side 100% + other side 50%), not to exceed billed charges.

Operational applicationApplied when the procedure code is reported with modifier 50 or on separate lines with LT/RT for the same structure, regardless of Multiple Procedure Indicator.

Interaction with other reductionsIf other reducible procedure codes are reported same date of service, an additional multiple procedure or imaging MPPR may or may not apply to the line paid at 100% depending on ranking.

inv-05: reimbursement adjustment for indicator '3'

Reimbursement adjustmentFor bilateral indicator '3': UnitedHealthcare reimburses 100% of the allowable amount for each side (sum = 200%), not to exceed billed charges.

Billing and Modifier Guidance for Providers

Billing Rule

Modifier 50 eligibility

Do not report modifier 50 on CPT/HCPCS codes unless the code is listed on UnitedHealthcare's Bilateral Eligible Procedures Policy List; codes not on the list reported with modifier 50 will not be reimbursed. CPT/HCPCS codes that include 'bilateral' or 'unilateral or bilateral' in their description are not on the Bilateral Eligible Procedures Policy List and are not eligible for modifier 50. If bilateral services are performed on multiple distinct sites beyond bilateral, use modifier 59 (or XS) with supporting medical record documentation.

Bill bilateral procedures on one line with modifier 50 and one unit with the full charge when the code is on the Bilateral Eligible Procedures Policy List.
When modifier 50 is used on a code not on the list, the code will not be reimbursed.
Use modifier 59 (or XS) only to report additional units for services performed on a different site or organ system and retain documentation to support site separation.

Key Definitions

inv-08: Definition — Bilateral Procedures

DefinitionBilateral Procedures: the same procedure performed on both sides of the body during the same session.

Coding implicationCPT/HCPCS codes that are unilateral but can be performed on both sides may be billed bilaterally when eligible; codes with 'bilateral' in their description are inclusive and should not use modifier 50.

Reporting noteWhen bilateral procedures are allowed, preferred billing is one line with modifier 50 and one unit with full charge for both procedures when allowed (per coverage guidance).

inv-09: Definition — Same Individual Physician or Other Qualified Health Care Professional

DefinitionSame Individual Physician or Other Qualified Health Care Professional: the same individual rendering health care services reporting the same Federal Tax Identification number.

Scope

Policy List Maintenance and Revision History

2026-03-29policy_list_changeLatest

Bilateral Eligible Procedures Policy List updated; history entries prior to 2024-03-29 archived.

2026-01-01policy_list_change

Codes with 'bilateral' and 'unilateral or bilateral' in the description lists and the Bilateral Eligible Procedures Policy List updated.

2025-11-01policy_list_change

Policy Summary

PayerUnitedHealthcare

PolicyBilateral procedure coding and reimbursement (CMS 1500)

Policy CodePolicy 2026R0023B

Change TypeRevisedClarifiedAdded

Effective Date

Next Review Date

Key ActionDo not report modifier 50 on CPT/HCPCS codes unless the code is on UnitedHealthcare's Bilateral Eligible Procedures Policy List; modifier 50 on ineligible codes will not be reimbursed.

SourceLink

On This Page

ApplicabilityApplies when the bilateral eligible code with indicator '3' is reported with modifier 50 and is not subject to Multiple Procedure or MPPR reductions.

Reference policyRefer to UnitedHealthcare Multiple Procedure and MPPR for Diagnostic Imaging Policies for potential interactions with other reductions.

Documentation Required

Billing for codes with 'unilateral or bilateral' in description

When a CPT/HCPCS code's description includes 'unilateral or bilateral' and the procedure is performed unilaterally, report the code as written (modifier 52 is not required) and any LT/RT modifiers are informational only. If only a bilateral description exists and no unilateral code is defined, report the bilateral code with modifier 52 when performed unilaterally.

If a unilateral procedure code exists, select the code that best represents the service.
When both LT and RT are reported for a code with 'bilateral' in the description, only one charge will be eligible for reimbursement up to the Maximum Frequency Per Day limit; LT/RT are otherwise informational when the service is performed on one side.
See UnitedHealthcare's Reduced Services Policy for more on reimbursement for reduced services and the Maximum Frequency Per Day Policy for MFD limits.

Definition applies to determination of when bilateral billing (modifier 50 or LT/RT on separate lines) represents services by the same rendering individual.

Billing consequenceIf services are not rendered by the same individual under the same Federal Tax Identification number, separate reporting conventions may apply.

Bilateral Eligible Procedures Policy List updated.

2025-09-21policy_list_change

Bilateral Eligible Procedures Policy List updated.

2025-07-21verbiage_update

Verbiage updated to reflect 'Qualified' Health Care Professional.

2025-06-29policy_list_change

Codes with 'bilateral' in the description list and Bilateral Eligible Procedures Policy List updated; history entries prior to 2023-06-29 archived.

2025-01-24policy_list_change

Bilateral Eligible Procedures Policy List updated; history entries prior to 2023-01-24 archived.

2025-01-01policy_list_change

Codes with 'bilateral' and 'unilateral or bilateral' in the description lists and the Bilateral Eligible Procedures Policy List updated.

2024-09-22policy_list_change

Codes with 'bilateral' and 'unilateral or bilateral' in the description lists updated.

2024-06-30policy_list_change

Bilateral Eligible Procedures Policy List updated; history entries prior to 2022-06-30 archived.

2024-04-01template_update

Content transferred to a shared policy template for UnitedHealthcare Commercial and Individual Exchange plans and application section updated.

1999-02-10policy_implemented

Policy implemented by UnitedHealthcare Employer & Individual and approved by the Clinical Review Committee.