Bilateral indicator 3

When billing in a linear fashion for a bilateral procedure, do I use 2 units if it has a bilateral indicator of 3?... and expect payment of 200%?

Bilateral

An indicator of "3" indicates the usual payment adjustment for bilateral procedures does not apply. If the procedure is reported with a modifier 50 or is reported for both sides on the same day by any other means (e.g., with RT and LT modifiers or with a 2 in the units field), reimbursement is based on 100% of the Medicare allowed amount for each side. Appropriate Usage for Modifer 50 for Medicare:
•When the procedure is done bilaterally AND the MPFSDB indicator for the procedure is "3", report the procedure code once; append with modifier 50 and report with one unit of service.
•This modifier is only appropriate when the service is performed on two bilateral body parts. Payment Policy Indicator 3 means the 150 percent payment adjustment for bilateral procedures does not apply. Services in this category are generally radiology procedures or other diagnostic tests which are not subject to the special payment rules for other bilateral procedures. NOTE: Although the 150 percent payment adjustment does not apply to payment policy indicator ‘3’, modifier 50 may be billed with these procedures. When billed with the 50 modifier, payment is based on the lower of the actual charges or 200 percent of the MPFS amount.

still confused :(

Still a little confused but I believe that your explanation has been my understanding. I am attempting to help another office, ophthalmology... not familiar to me, and they are being told by Palmetto GBA that they need to rebill all their denials in questions with 2 units. The code they have been using is 92135-50 with one unit and are being paid at 100% of fee schedule. They were directed to the article below and the article does seem to indicate using 2 units or multi-line billing. Is that your understanding.... is it a change?

http://www.palmettogba.com/Palmetto/Providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~Modifier%20Lookup~CPT%20Modifier%2050?open&navmenu=

Ophthalmology code 92135 -

Should use RT and LT, not modifier -50 for this service. But, When coding for two procedures, one performed on each eye, different billing approaches may be used as described below:
Bill 92135 as a single line item with a unit of two
Bill 92135-50 as a single line item with a unit of one
Bill 92135-RT and 92135-LT each as a single line item with a unit of one
Check with your local Medicare carrier to determine which method is most appropriate for your area. Ophthalmology can be a different animal, ex, code 92136 TC is considered bilateral but the -26 is considered unilateral.

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