Name of Manual - Blue Cross and Blue Shield of Minnesota

Bilateral Services
(continued)
Coding Policies and Guidelines (Surgical Services)
Bilateral billing for freestanding Ambulatory Surgical Centers
Because Medicare differs in bilateral billing instructions for
freestanding ASCs, the Minnesota Rule found in Table A.5.1 of
the Minnesota Department of Health Minnesota Companion Guide
clarifies the bilateral modifier rules for Minnesota providers and
payers.
Modifier 50 should be used on surgical services that can be
performed bilaterally and are not already defined as a bilateral
service. When appropriate, report the service appended with the 50
modifier on one line with one unit.
Professional bilateral radiology services are reported as two lines
with LT and RT modifiers.
Unlisted Procedures If a code cannot be found for a surgical procedure, submit the
unlisted code from the related section of CPT and attach an
operative report to the claim. If not attached, records will not be
requested and the claim will not be processed without the
information.
Facility Fees for Office
Surgery
Blue Cross does not allow a separate reimbursement for approved
office surgery suites. No additional reimbursement will be made
for fees associated with procedures performed in office surgical
suites regardless if the service(s) is modified with the –SU or –SG
modifier. This includes additional units of service for the
preoperative preparation, anesthesia and surgical trays.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (03/19/12)
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