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Oct 1, 2024

Surgical Procedure Anatomical Modifier

Procedure codes in the range 10000-69999 having a Medicare Physician Fee Schedule (MPFS) bilateral indicator ‘1’, designating the code is eligible to be billed on both sides of the body, must be billed with the appropriate anatomical modifier. Without the proper anatomical modifier applied to the procedure code, there is risk of duplicate claims payment, incorrect procedure to procedure bundling, incorrect frequency limitations, and unnecessary medical record review.