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aloralsurgery
Canine II

Filing Bilateral Medical Procedures?

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I was wondering if anyone has any insight to this, or how other offices may be handling this situation.

We are an oral surgeon's office that deals with both dental and medical insurances. BCBS of Alabama medical policies (and probably some others) have implemented a new requirement on how we should file bilateral procedures. If we do a bilateral procedure, we are to file the code only once with a unit of "1", and add modifier 50. The modifier is how they will know to consider 150% of the allowed amount due to the multiple procedures reduction. If we do it that way, the ledger will not add up on our side. Should we leave the unit as "1" and just double the price when filing? 

Hopefully that makes enough sense.

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sherylbreault
CS Dental Employee
CS Dental Employee

Hello, what you are proposing here makes sense to me. As long as the insurance is considering 150% when you use the 50 modifier, then you should be doubling the charge for the procedure code. This way when you send it to insurance they will be paying off the higher amount to cover both procedures.

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sherylbreault
CS Dental Employee
CS Dental Employee

Hello, what you are proposing here makes sense to me. As long as the insurance is considering 150% when you use the 50 modifier, then you should be doubling the charge for the procedure code. This way when you send it to insurance they will be paying off the higher amount to cover both procedures.

tshaw
Community Manager
Community Manager

@sherylbreault @Alan_L do either of you have any input on this? 

I suppose there are no updates?

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