Modifier 52

Partially Reduced or Eliminated Services

Instructions

This modifier is used to indicate partial reduction, cancellation or discontinuation of services for which anesthesia is not planned. It provides a means for reporting reduced services without disturbing the identification of the basic service and identifies a situation where a physician reduces or eliminates a portion of a service or procedure. Medicare claims processing system will reimburse for lower of actual charge or Medicare Physician Fee Schedule (MPFS) allowance  

Correct Use

  • Append when reporting professional portion of procedure(s) under 096X, 097X or 098X revenue codes for Critical Access Hospital (CAH) Method II outpatient type of bill (TOB) 851s
  • When appending, include the following on CMS UB-04 claim form (or electronic equivalent):
    • A statement which indicates "reduced services" in remarks section Form Locator (FL) 80
    • A brief reason for reduction
    • Appropriate charge amount
      • Reduce normal fee by percentage of service not provided
  • When appending, documentation must include complete reduction reason retained in patient's record

Resource

 

Last Updated Tue, 14 Jan 2020 15:11:22 +0000