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Modifier 51

Modifier 51 denotes more than one medical/surgical procedure is being performed by the same physician on the same day during the same encounter. (Does not include E&M services.)

Modifier 51 is a Medicare contractor assigned modifier; Medicare does not recommend reporting modifier 51 on your claim submission. Our claims processing system has hard-coded logic to add the 51 modifier to the correct procedure code. When the Medicare contractor appends the 51 modifier to your claims, this will be reflected on the provider remittance advice (RA).

Definitions

  • Multiple surgeries performed on the same day, during the same surgical session.
  • Diagnostic imaging services subject to the MPPR that are provided on the same day, during the same session by the same provider.

Appropriate System Usage 

  • When both diagnostic procedures have an indicator of "4" in the MPFSDB "Mult Surg" column, and both diagnostic procedures have the same "Diagnostic Imaging Family Indicator" in the MPFSDB.
  • When the same physician performs more than one surgical service at the same session.
  • When the MPFSDB indicates a "01-11" in the "Diagnostic Imaging Family Indicator" column.
  • When both surgical procedure codes have an indicator of "2" in the MPFSDB "Mult Surg" column.
  • Append modifier 51 to the surgical procedure code with the lower physician fee schedule amount.
  • Append modifier 51 to the diagnostic imaging procedure with the lower technical component fee schedule amount.

Inappropriate System Usage

  • Do not report on all lines of service.
  • Do not use
    • on procedures that are considered components or incidental to a primary code or designated as add-on-codes.
    • on instances in which two or more physicians each perform distinctly different surgeries on the same day on the same patient.

Additional Information 

  • Medicare pays for multiple surgeries by ranking from the highest physician fee schedule amount to the lowest physician fee schedule amount.
    • 100% of the highest physician fee schedule amount.
    • 50% of the physician fee schedule amount for each of the other codes.
  • Medicare will forward the claim information showing modifier 51 to the secondary insurance.
  • Multiple surgery pricing logic also applies to assistant at surgery services.
  • Multiple surgery pricing logic applies to bilateral services (modifier 50) performed on the same day with other procedures.

Related Content

CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 23 (2 MB)

Modifier 51
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