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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that providers/suppliers must report services correctly. Procedures should be reported with the 
Current Procedural Terminology (CPT) code that describes the services performed. You can find this rule in 
the Centers for Medicare and Medicaid Services, Medicare National Correct Coding Initiative Policy Manual 
for Medicare Services, Chapter I(A). 
 
Per 2022 National Physician Fee Schedule Relative Value January Release, CPT code 64493-RT, 64493- 
LT, 64494-RT and 64494-LT has a bilateral surgery indicator of "1".  
 
Per Medicare Claims Processing Manual Chapter 23 - Fee Schedule Administration and Coding Requirements, 
Section 50.6  Physician Fee Schedule Payment Policy Indicator File Record Layout: 1 = 150 percent payment 
adjustment for bilateral procedures applies. If code is billed with the bilateral modifier base payment for these 
codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides, or (b) 150 
percent of the fee schedule amount for a single code. If code is reported as a bilateral procedure and is reported 
with other procedure codes on the same day, apply the bilateral adjustment before applying any applicable 
multiple procedure rules. 
 
Per National Correct Coding Initiative Policy, Chapter 1 - General Correct Coding Policies, Sec-V -Medically 
Unlikely Edits: MUEs for HCPCS codes with an MAI of 2 are absolute date of service edits. These are per 
day edits based on policy. HCPCS codes with an MAI of 2 have been rigorously reviewed and vetted within 
CMS and obtain this MAI designation because UOS on the same date of service (DOS) in excess of the MUE 
value would be considered impossible because it was contrary to statute, regulation, or subregulatory guidance. 
This subregulatory guidance includes clear correct coding policy that is binding on both providers and CMS 
claims processing contractors. Limitations created by anatomical or coding limitations are incorporated in 
correct coding policy, both in the HIPAA mandated coding descriptors and CMS approved coding guidance as 
well as specific guidance in CMS and NCCI manuals. For example, it would be contrary to correct coding 
policy to report more than one unit of service for CPT 64493-RT, 64493-LT, 64494-RT and 64494-LT 
(Ventilation assist and management . . .initial day) because such use could not accurately describe two initial days of management occurring on the same date of service as would be required by the code descriptor. As a 
result, claims processing contractors are instructed that an MAI of 2 denotes a claims processing restriction 
for which override during processing, reopening, or redetermination would be contrary to CMS policy. If the 
bilateral surgery indicator is 1, a bilateral procedure must be reported with 1 unit of service and modifier 50 
(bilateral modifier). There is no additional payment for the code if reported as a unilateral or bilateral procedure 
because of anatomy or physiology. Alternatively, the code descriptor may specifically state that the procedure 
is a unilateral procedure, and there is a separate code for a bilateral procedure. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.