53 - JE Part B
Discontinued Procedure (professional services only)
This modifier allows the physician community to state the surgical procedure was discontinued due to extenuating circumstances or a threat to patient well-being.
- Append in first pricing position
- Under certain circumstances, physician may elect to terminate surgical or diagnostic procedure
- Surgical or diagnostic procedure started and discontinued by physician
- Prior to or after anesthesia is administered
- Bill Medicare percentage of service completed (see second example below)
- Medicare Claims Processing System does not automatically reduce payment
- Do not use to report elective procedure cancellation, in operating suite, prior to patient's anesthesia induction and/or surgical preparation
- Inappropriate with E/M or anesthesia codes
- Inappropriate to use for Ambulatory Surgery Center (ASC) or hospital facility claims. Use facility modifiers 73 or 74
- Do not confuse with "reduced procedure" modifier 52
Claim Coding Example
|Sigmoidoscopy; flexible; diagnostic||45330 53|
Claim Reduction Fee Example
Provider performs 60% of service, reducing charges and appends modifier 53.
|Medicare Physician Fee Schedule (MPFS) Allowed*||$200|
|Bill Reduced Amount ($200 x 60%)||$120|
*Medicare recognizes that many providers use one standard fee schedule for all insurance carriers. Therefore, reducing the charge amount may differ from the example.
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.1
Last Updated Mon, 24 Oct 2022 20:02:45 +0000