Modifier 52, reduced services
Report modifier 52 when a component of a CPT code definition is reduced or eliminated. Append modifier 52 to the CPT code that represents the basic service to indicate that the basic service was performed but a one component of the service/CPT code definition was not.
- Do not use modifier 52 when there is a CPT code that accurately describes the service(s) performed.
- Facilities reporting discontinued procedures should use modifier 73 or 74.
Modifier 52 reimbursement
Effective 04/01/2013, reimbursement under all plans will be 50% of the base fee schedule. This does not include MSD reduction, bilateral pricing, etc. that may also be applied.
Priority Health may request notes to determine the extent of services rendered.
Reference the CPT Manual for additional instruction.
- Anesthesia modifiers
- AT: Active treatment
- GA and GY: Medicare non-coverage notification
- GN, GO & GP: Therapy type
- UD and UA: Treated and released or admitted/transferred (Medicaid only)
- XE, XS, XP, XU: Distinct services
- 22: Unusual procedural services
- 25: Significant service separate from E&M service
- 26 and TC: Professional and technical components
- 33: Preventive service
- 50 & 51: Bilateral and multiple procedures
- 52: Reduced services
- 53: Discontinued procedure
- 54 & 55: Surgical care and post-op care
- 56: Pre-operative management only
- 59: Distinct procedural service
- 62: Two surgeons
- 73 & 74: Discontinued outpatient surgery
- 76 & 77: Repeated procedures, same day
- 78: Unplanned return to operating room
- 80, 81, 82: Assistant at surgery