Glossary · Updated Jul 28, 2026
Bilateral Surgery Indicator
The bilateral surgery indicator tells you how Medicare adjusts payment when a procedure is performed on both sides of the body — most often billed with modifier 50. It has five possible values, and the payment effect is completely different from one to the next.
What the values mean
Indicator 1 means the standard 150% bilateral adjustment applies — bill once with modifier 50 and Medicare pays 150% of the single-side amount. Indicator 2 means the published RVUs already build in bilateral pricing, so no further adjustment applies. Indicator 3 means each side is simply paid at 100%, subject to the usual multiple-procedure rules for anything else billed the same day. Indicator 0 means the 150% adjustment does not apply to this procedure at all, and indicator 9 means the bilateral concept does not apply — the procedure is not one Medicare considers bilaterally.
Bilateral surgery indicator values
All five values, in one table:
| Value | Meaning |
|---|---|
| 0 | No bilateral adjustment applies |
| 1 | 150% bilateral adjustment applies |
| 2 | RVUs already reflect bilateral pricing |
| 3 | Both sides paid at 100%; standard multiple-procedure rules apply |
| 9 | Bilateral concept does not apply |
Where to see it applied
Every code page shows this code's bilateral indicator in its billing-policy panel, and — when the indicator is 1, 2, or 3 — a computed -50 amount in the modifier amounts section, for example CPT 99213.
Frequently asked
Does every procedure allow bilateral billing?
No. Indicators 0 and 9 mean bilateral billing either gets no special adjustment or the concept does not apply to that procedure at all.
Why is indicator 2 not a 150% payment?
When the RVUs already reflect that a procedure is inherently bilateral, adding the 150% multiplier on top would double-count the adjustment CMS already built into the relative value.
Sources
- CMS Medicare Physician Fee Schedule Relative Value Files
- CMS Physician Fee Schedule overview (cms.gov)
Written from primary CMS sources — see how we source, compute, and verify everything on this site.
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