Radiology Question for the Week of December 23, 2024

Question:

Do you have any more tips for using Modifier 50 successfully in 2025?

Answer:

According to CMS, modifier 50 may be applied to breast procedures performed bilaterally. Per AMA/CPT instruction, this modifier should not be appended to designated “add-on” codes (i.e., those with a “+” sign in front of them in CPT). For a complete listing of all add-on codes, refer to Appendix D in the CPT® manual. Per CMS instructions, modifier 50 may be allowed with add-on codes in accordance with MUE/MAI values. Be aware that individual payers can make and apply their own policy rules. Modifier 50 is used to report bilateral procedures that are performed at the same operative session as a single line item. Report the appropriate five-digit code to describe the radiological and/or surgical procedure code and append modifier 50. You must not submit two line items to report a bilateral procedure unless directed otherwise.

This question was answered in our Breast & Bone Density Procedure Coding Guide. For more hot topics relating to radiology services, please visit our store or call us at 1.800.252.1578, ext. 2.