- Anesthesia Modifiers
- Appropriate Usage of Modifier 99
- Assistants at Surgery at Teaching Hospitals
- Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission
- Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, T1-T9 and TA vs. Modifier 50
- Correct Usage of Modifier 79 for Multiple Procedures
- Co-Surgery/Team Surgery/Assistant Surgery Modifiers
- Modifier 25
- Modifier 33
- Modifier 51
- Modifier 52 Claim Submission Billing Reminder
- Modifier 59 and the Subset Modifiers XE, XP, XS, XU - Specific Modifiers for Distinct Procedural Services
- Modifier 90 Reference to Outside Laboratory
- Modifiers
- Modifier Usage
- Proper Billing of Surgical Comanagement (Modifiers 54 and 55)
- Proper Use of Modifiers 59 and 91
- Reminder for Submission of Modifier 22
- Repeat Procedures - Modifiers 76 and 77
Modifier 52 Claim Submission Billing Reminder
National Government Services found that on many occasions, providers are billing for reduced services with modifier 52 appended to the CPT code; however, they are billing the regular charged amount for the procedure. In some of these cases this type of billing could lead to an overpayment.
When billing for a reduced service, providers should reduce their fees accordingly to reflect the percentage of the procedure performed. A bilateral procedure code could be reduced by 50% if performed unilaterally. However, other services should have their fees reduced based on the procedure actually performed. Maintaining the same charge for a reduced service is not proper billing. Please make sure that when you submit any CPT code with modifier 52 that you are reducing the billed amount by the appropriate percentage of the Medicare allowed amount, not the usual provider’s fee for the services.
Modifier 52 is not appropriate coding for situations when there is a code that would represent the reduced service that was actually performed.
Example: CPT code 71020 (radiologic examination, chest, two views, frontal and lateral) is ordered. Only one frontal view is performed. CPT code 71010 (radiologic examination, chest: single view, frontal) is reported. The service is not reported as CPT code 71020-52.
Modifier 52 is not valid for submission with E/M services. Medicare does not recognize modifier 52 for this purpose. If modifier 52 is used on an E/M service code, the code will be rejected.
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Revised 8/4/2022