Payment for BIlateral procedure of ASC

Payment and Billing of Bilateral Procedures

A procedure performed bilaterally in one operative session should be reported as two procedures, either as a single unit on two separate lines or with “2” in the units field on one line. The multiple procedure reduction of 50 percent applies to all bilateral procedures subject to multiple procedure discounting.

Example
Code 31020 is performed bilaterally in one operative session.
• Report 31020 on two separate lines.
Or,
• Report 31020 with “2” in the units field.

Depending on whether the claim includes other services to which the multiple procedure discount applies, the contractor applies the multiple procedure reduction of 50 percent to the payment for at least one of the CPT code 31020 payment rates.

Therefore, Medicare will treat payment for a procedure performed bilaterally the same as payment for multiple procedures. For example, if sinusotomy, maxillary (antrotomy); intranasal (CPT code 31020), is performed bilaterally in one operative session, ASC facilities should report it as CPT code 31020 performed two times. Medicare will then calculate payment for bilateral procedures by multiplying the appropriate wage-adjusted payment amount by 150 percent.

To determine if a procedure may be billed bilaterally, providers should verify the procedure code to the Medicare Physician Fee Schedule Database (MPFSDB). Certain procedures within the MPFSDB are established to reimburse bilaterally and the allowed amount reflects bilateral payment. Other procedures may be considered to be performed bilaterally; however, the claim must be billed indicating the service was performed bilaterally.