LCD Reference Article Billing and Coding Article

Billing and Coding: Use of Laterality Modifiers

A56869

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD.

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General Information

Source Article ID
N/A
Article ID
A56869
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Use of Laterality Modifiers
Article Type
Billing and Coding
Original Effective Date
09/09/2019
Revision Effective Date
01/01/2022
Revision Ending Date
N/A
Retirement Date
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CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

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Article Guidance

Article Text

In order to facilitate claims processing and avoid denials for duplicate claims, claims which contain CPT®/HCPCS codes describing services performed on anatomic structures that can be distinguished as left or right require laterality modifiers. This article is not a comprehensive listing of all such codes; however, all claims involving the CPT® codes included in this article will be rejected unless the appropriate laterality modifiers (-RT; -LT) for unilateral procedures are reported. Bilateral procedures should be indicated by the appropriate modifier for bilateral procedures. CPT® codes that are designated in their description as “unilateral or bilateral” do not require additional laterality modifiers.

Claim lines for CPT®/HCPCS codes requiring use of the RT and LT modifiers, submitted without the RT and/or LT modifiers or with the RT/LT on a single claim line will be rejected as incorrect coding.

Response To Comments

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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

(2 Codes)
Group 1 Paragraph

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Group 1 Codes
Code Description
LT LEFT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE LEFT SIDE OF THE BODY)
RT RIGHT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE RIGHT SIDE OF THE BODY)
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ICD-10-CM Codes that Support Medical Necessity

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Group 1 Codes

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ICD-10-CM Codes that DO NOT Support Medical Necessity

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Group 1 Codes

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ICD-10-PCS Codes

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2022 R3

Under CPT/HCPCS Codes Group 1: Codes deleted 0191T and added 66989, 66991, 68841, 0671T and 0699T. This revision is due to the 2022 Annual CPT®/HCPCS Code Update and becomes effective on 1/1/2022.

01/01/2020 R2

Under CPT/HCPCS Codes Group 1: Codes added CPT® codes 66987 and 66988. The code descriptions were revised for CPT® codes 66982 and 66984. This revision is due to the Annual CPT®/HCPCS Code Update and becomes effective on 1/1/2020.

10/03/2019 R1

Under CPT/HCPCS Modifiers added modifiers LT and RT.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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SAD Process URL 1
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SAD Process URL 2
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
12/27/2021 01/01/2022 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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