CommercialBilling CodesMedium impact
Bilateral surgery and modifier 50
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, General Surgery, Cardiothoracic Surgery +8 more·Physician / Facility
Effective date
Jan 1, 2020
We identified it
Jun 19, 2026
Summary
BCBSRI will follow CPT coding guidelines instead of CMS policies for bilateral surgery modifier 50. Claims with modifier 50 on procedures with inherently bilateral descriptors (containing 'unilateral or bilateral') will be denied, even though CMS may allow the modifier.
Action Required
Immediately: Review all bilateral surgery claims before submission to BCBSRI. Do not use modifier 50 on CPT codes that have 'unilateral or bilateral' in their descriptors. Update billing system rules to flag these combinations for review. Train billing staff to check CPT code descriptors rather than following CMS guidelines for BCBSRI claims.