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Modifiers

  1. If a provider attempts to perform a procedure which is unsuccessful (e.g., remove a foreign body by incision and no foreign body is removed) is this a reduced or discontinued procedure? What modifier is appropriate?

    Answer:
    Modifier 52 describes a situation in which the physician performs a reduced service; this would be the appropriate modifier for a service not fully completed.

    Please see the NGS Job Aid on our website titled, “Modifier 52 Claim Submission Billing Reminder,” which instructs providers to bill at a lower rate, based on this situation: “Please make sure that when you submit any CPT code with modifier 52 that you are reducing the billed amount by the appropriate percentage of the Medicare allowed amount, not the usual provider’s fee for the services.” Updated 6/9/2017

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