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.

Instructions

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.

Incorrect Use

• 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

Resource

• OCE Quarterly Release Files