Ask an Expert

Answers to Compliance and Medical Coding Questions.
  1. Leorah Posted 1 Year(s) agoRelated Topics

    Hi, I am noticing that when I have 2 codes with a 50 modifier, for example a 36224(50) and then a 36226(50) the primary code 36224 will be paid at 150%(100% for primary and 50% for the additional) and the 36226 with the 50 modifier are paid two different ways. 1) will sometimes be paid at 75%(50% first and 25% for the second) 2) sometimes paid 100% (50% first and 50% second). Do you know which way Medicare and Medicaid follow? Thank you, Lee

  2. SuperCoder Posted 1 Year(s) ago


    Kindly consider the following link for referral :

    Hope this helps!

  3. Leorah Posted 1 Year(s) ago

    Thanks for your help. This link describes rules of modifier 50 by CMS. Can I assume that if Medicare considers a code to be eligible for 150% when coded with a 50, then Medicaid would agree? Thank you

  4. Leorah Posted 1 Year(s) ago

    I was looking over this link that you sent and I just don't understand from the site when 150% is paid and when not. Could you please explain it in your own words? Thank you so much

  5. SuperCoder Posted 1 Year(s) ago


    The bilateral surgery payment policy indicators on the MPFS to determine if the 150 percent payment adjustment is payable for a specific Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) code.

    A) For payment policy indicator 0 : code descriptor should specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure.

    B) For payment policy indicator 2 : code descriptor should state that the procedure is bilateral, the codes descriptor state that the procedure may be performed either unilaterally or bilaterally, or the procedure is usually performed as a bilateral procedure.

    For Payment Policy Indicator 1, the 150 percent payment adjustment for bilateral procedures does apply. The policy indicators apply to both medicare and medicaid.

    Hope this helps! 


About this Question

  • Posted by 115517 Leorah, 1 Year(s) ago. There are 5 posts. The latest reply is from SuperCoder.