CurrentUnitedHealthcarePolicy 2025R9009A

Bilateral Procedure Reimbursement

Governs UnitedHealthcare Medicare Advantage reimbursement for bilateral surgical procedures billed on the CMS 1500 form, including modifier use and payment adjustments; affects network physicians and other qualified health care professionals providing services to UnitedHealthcare Medicare Advantage enrollees.

Policy Summary

PayerUnitedHealthcare

PolicyBilateral Procedure Reimbursement

Policy CodePolicy 2025R9009A

Change TypeNon‑material revisions (definitions and resources updated)

Effective Date

Next Review Date

Key ActionBill bilateral procedures with modifier 50 when appropriate and apply a 150% payment adjustment when the NPFS bilateral indicator = 1.

SourceLink

POLICY UPDATE CHANGES

Application Section updated; Definitions section updated Same Provider Definition to reflect 'NPI'.

Resources section updated.

Policy version change history entry dated 6/1/2025.

150%payment adjustment when indicator = 1

100%base payment when not bilateral

2025R9009Adocument id

CMS 1500claim form

Bilateral Procedure Billing and Payment

Bilateral Procedure Billing and Payment Criteria

Billing and payment adjustment rules for bilateral procedures for UnitedHealthcare Medicare Advantage.

If a procedure can be billed bilaterally, bill the service with modifier 50; do not report modifier 50 for codes whose terminology already includes 'bilateral' or 'unilateral or bilateral'.

Do not report LT/RT when modifier 50 applies; exception: Ambulatory Surgical Centers (CMS Specialty 49) are excluded from the 50 modifier requirement and should bill on two lines with LT/RT per CMS and NCCI rules.

When the NPFS bilateral indicator is '1', apply a 150% payment adjustment for bilateral procedures.

If a procedure with indicator '1' is billed twice or reported with modifier 50 (or with RT/LT or units = 2), payment will be the lower of: the total actual charge for both sides OR 150% of the fee schedule amount for a single code.

Policy Summary

PayerUnitedHealthcare

PolicyBilateral Procedure Reimbursement

Policy CodePolicy 2025R9009A

Change TypeNon‑material revisions (definitions and resources updated)

Effective Date

Next Review Date

Key ActionBill bilateral procedures with modifier 50 when appropriate and apply a 150% payment adjustment when the NPFS bilateral indicator = 1.

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.

Provider Responsibilities and Policy Updates

Note

Provider Responsibilities and Policy Updates

UnitedHealthcare Medicare Advantage may modify this reimbursement policy at any time to comply with changes in CMS policy and other national standard coding guidelines by publishing a new version of the reimbursement policy on this website. The information presented in this reimbursement policy is accurate and current as of the date of publication. Providers are encouraged to keep current with CMS policy changes and billing requirements by regularly referring to the CMS or local carrier website and signing up for policy or regulatory change distributions from CMS and/or their local carrier. UnitedHealthcare Medicare Advantage reimbursement policies do not include notations regarding prior authorization requirements. For information on a specific enrollee's benefit coverage, call the customer service number on the back of the member ID card.

Keep current with CMS and local carrier policy changes by checking their websites regularly.
Sign up for CMS or local carrier distributions for policy/regulatory updates.
UnitedHealthcare Medicare Advantage may publish a new version of this reimbursement policy at any time to reflect CMS or coding guideline changes.
This policy does not indicate prior authorization requirements — verify prior auth separately with the plan or member benefits.
For enrollee-specific coverage questions, contact customer service using the number on the member ID card.

Key Definitions

Same Individual Physician or Other Qualified Health Care Professional

Definition (term)Same Individual Physician or Other Qualified Health Care Professional

Identifier usedSame Federal Tax Identification number (or NPI as updated in definitions)

Context of useApplies when determining whether multiple services are from the same provider for bilateral billing rules

Bilateral Procedures

Definition (term)Bilateral Procedures

DescriptionThe same procedure performed on both sides of the body during the same operative session or on the same day.

Inherently bilateral codesIf a code's description includes 'bilateral' it is inherently bilateral and should not be reported with modifier 50; report unilateral code or use modifier 52 if no unilateral code exists.

50	Bilateral procedure modifier
LT	Left side modifier
RT	Right side modifier
59	Distinct procedural service modifier

OpenPayer

Bilateral Procedure Reimbursement

Bilateral Procedure Billing and Payment

Modifiers, Code Sets, and Payment Multipliers

Provider Responsibilities and Policy Updates

Key Definitions