51 - JE Part A
Modifier 51 indicates more than one medical/surgical procedure (multiple procedures other than E/M) were performed by the same physician on the same day at the same operative session.
This modifier is not required. The Medicare claims processing system has hard-coded logic which applies the multiple procedure reduction policy; therefore, we do not recommend that providers report this modifier on a claim.
Modifier 51 should only be appended when a secondary insurance required it and the following are true.
- When both diagnostic procedures have an Outpatient Code Editor (OCE) status indicator of S or T
- When same physician performs more than one surgical service at the same session
- Append modifier 51 to the procedure code with the lower fee schedule amount.
- For procedures that are considered components or incidental to the primary procedure or add-on codes
- When two or more physicians each perform distinctly different, unrelated surgeries on the same day, on same patient
- If one surgeon performs multiple surgeries
- To all lines of service
Last Updated Mon, 12 Dec 2022 15:40:24 +0000