Procedures eligible for bilateral (modifier 50) available through Clear Claim Connection™

The bilateral modifier 50 fees will no longer be displayed on Entire Fee Schedules, published on web-DENIS, for effective dates on or after July 1, 2014. Also, beginning April 1, 2014, they won’t be displayed on fee change schedules.

The Entire Fee Schedules are published annually and there are procedure code changes related to modifier 50 occurring quarterly. That means providers can determine procedure codes and verify modifier 50 eligibility by accessing Clear Claim Connection™, also known as C3.  

C3 is our provider-facing claim simulation tool. Be sure to review the terms and conditions page for applicable services this tool relates to. Clinical edits and rationale contained within C3 must not be used as a guarantee of payment or a source of benefit policy information.

For your convenience, in addition to the link currently available through web-DENIS, we’ve added a link to C3 to the Entire Fee Schedules and Fee Changes front page. That will allow you to validate modifier 50 eligibility by entering the procedure code and modifier 50 in C3.

You can calculate the bilateral fee this way:

• If the code is radiology or an add-on code, the modifier 50 fee will be 200 percent of the non-modifier 50 (single procedure) fee.
• Otherwise, the modifier 50 fee will be 150 percent of the non-modifier 50 (single procedure) fee.

For more information about Clear Claim Connection™, see the article in the February 2012 Record or contact your provider consultant.