June 11, 2020

Question:
I did a posterior lumbar fusion bilaterally. Can I bill 22612 with modifier 50 for bilateral procedures? I looked at CPT and it doesn’t say that I can’t bill modifier 50 on any of the fusion codes.

Answer:
Interesting question! This brings up the point that the CPT book can’t possibly include every single detail of every single code otherwise the book would be very large. The spine is considered a central structure, from CPT’s perspective, and without laterality. This means no use of modifier 50 unless the code specifically states “unilateral.” So the answer to your question is no, CPT 22612 may not be reported with modifier 50.

*This response is based on the best information available as of 6/11/20.