52 - JE Part A

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

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 20.6