US · guidance
CMS Pub. 100-04, ch. 4, § 250.11.2
Payment of Bilateral Procedures Rendered in a Method II
CAH
(Rev. 1777; Issued: 07-24-09; Effective Date: 01-01-08; Implementation Date: 01- 04-10)
Under Section 1834(g)(2)(B) of the Act, outpatient professional services performed in a
Method II CAH are paid 115 percent of such amounts as would otherwise be paid under
the Act if the services were not included in the outpatient CAH services.
Payment for bilateral procedures with a payment policy indicator of ‘1’ and the 50
modifier is based on the lesser of the actual charges or the 150 percent payment
adjustment for bilateral procedures and is calculated as follows:
• (facility specific MPFS amount times payment adjustment for bilateral procedures
(150%) minus (deductible and coinsurance)) times 115%
Payment for bilateral procedures with the 50 modifier and a payment policy indicator of
‘3’ is based on the lesser of the actual charges or 100% of the MPFS for each side of the
body (200%) and is calculated as follows:
(facility specific MPFS amount times 200% minus (deductible and coinsurance)) times
115%
History
(Rev. 1777; Issued: 07-24-09; Effective Date: 01-01-08; Implementation Date: 01- 04-10)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
397e61fb2eebb0ef846f8e193ca5291bca1520468492108111dc5dfc4026a800
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.