What are your guidelines for multiple and bilateral procedures (modifiers 50 and 51)?

Primary procedures will be paid at 100 percent of the contracted amount; reduced reimbursements will be applied to second and subsequent procedures. We apply these reductions whether or not modifiers 50 and 51 are present on the claim.

How are unlisted CPT codes reimbursed?

Unlisted CPT codes receive a percentage discount as negotiated in provider contracts.

How are HCPCS codes repriced?

HCPCS codes may be assigned specified rates as any other CPT code or a percent-off-of-charge flat rate discount is applied.

Do you have organ transplant package pricing in place or any specific transplant contracts?

Yes. Certain provider contracts do include global organ transplant reimbursement arrangements. Reimbursement rates vary by contract.


For additional information about reimbursement provisions, e-mail payer relations.