Bilateral (Modifier 50) Payment by Indicator

Bilateral-surgery payment by the MPFS bilateral indicator (0/1/2/3): the allowed amount for the bilateral pair as a percentage of the fee schedule.

Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.

Example

Fee-schedule amount: 500 $
Bilateral indicator: 1

Result: Indicator 1 pays 150% of the pair: $750.00 allowed.

The tool opens with these values already filled in. Replace them with your own.

What you enter

Fee-schedule amount
Bilateral indicator (0, 1, 2, or 3)

How this is calculated

CMS Pub. 100-04, Ch. 12 40.7; MPFS BILAT SURG indicator (0 not allowed; 1 = 150% of the pair; 2 = already priced bilateral, 100%; 3 = pay each side full; 9 = does not apply). Read the source ↗

A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.