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Modifier 52

National Government Services has found that on many occasions providers are billing for reduced services with modifier 52 appended to the CPT code; however, they are billing the regular charged amount for the procedure. In some of these cases, this type of billing could lead to an overpayment. 

When billing for a reduced service, providers should reduce the billed amount by 50% just as providers are to increase a bilateral billing by 50%. Maintaining the same charge for a reduced service is not proper billing. Please make sure that when you submit any CPT code with modifier 52 that you are also reducing the billed amount by 50% prior to submission to Medicare.

Modifier 52
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