What is the 52 and 73 modifier?
Asked by: Kaylie Ruecker | Last update: May 16, 2025Score: 5/5 (8 votes)
What is the modifier 52 or 73?
When coding and billing for a facility, the 52 modifier is used to indicate a partial reduction or discontinuation of radiology procedures or services that do not require anesthesia. Modifiers 73 and 74 cannot be used to report facility services for discontinued radiology procedures that do not require anesthesia.
What is a 52 modifier used for?
Modifier -52 identifies that the service or procedure has been partially reduced or eliminated at the physician's discretion. The basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
What is an example of a 73 modifier?
Modifier 73 example:
The patient is taken to the operative room, surgically prepped, and prior to general anesthesia, the patient is found to have high blood pressure. Due to this finding, the provider decides to cancel the procedure. In this case, you would assign the appropriate CPT® code with modifier 73 appended.
How much does modifier 52 reduced reimbursement?
There are no industry standards for reimbursement of claims billed with modifier 52 from the Centers for Medicare and Medicaid Services (CMS) or other professional organizations. UnitedHealthcare's standard for reimbursement of Modifier 52 is 50% of the Allowable Amount for the unmodified procedure.
When To Use A Modifier in Medical Coding
What is modifier 72?
Modifier 72: Resumed Service Post-Surgical
Modifier 72 is applied when services need to be resumed during a global period for post-operative care due to unforeseen complications.
How the use of modifier affects the reimbursement amount?
Modifier is important because they help ensure accurate documentation and maximize reimbursement. They can help avoid claim denials and improve reimbursement rates by providing specific information about services or procedures.
Which best describes modifier 73?
ASCs use modifier -73 to indicate a surgical procedure was terminated prior to induction of anesthesia or initiation of the procedure.
What is modifier 53 used for?
Appropriate use modifier 53:
Bill modifier 53 with the CPT code for the service furnished. This modifier is used to report a service or procedure when the service or procedure is discontinued after anesthesia is administered to the patient.
What is the 73 CPT modifier?
Discontinued outpatient hospital/ambulatory surgical center (ASC) procedure prior to the administration of anesthesia. This modifier may not be submitted by the operating surgeon. Only ASCs should submit this modifier.
What is the modifier 52 for colonoscopy?
Therapeutic colonoscopies that are incomplete (the scope does not reach the cecum during a therapeutic procedure) are reported with modifier 52. It is important to note that the codes for reporting these procedures differ between Medicare and other payors.
What is modifier 59 used for?
For the NCCI, the primary purpose of CPT® modifier 59 is to indicate that two or more procedures are performed at different anatomic sites or during different patient encounters. It should only be used if no other modifier more appropriately describes the relationships of the two or more procedure codes.
Can you bill for a failed procedure?
Procedures may need to be terminated or discontinued for various reasons, including complications that may put the patient at risk. If the patient was in the operating or procedure room when the procedure was cancelled, the encounter can be coded and billed. Documentation is still required to support the encounter.
What is the 52 modifier used for?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
Why would a TC be billed and not PC?
Modifier TC is used when only the technical component (TC) of a procedure is being billed when certain services combine both the professional and technical portions in one procedure code. Use modifier TC when the physician performs the test but does not do the interpretation.
What is modifier 73 used for?
Use modifier 73 to report discontinued outpatient/hospital ambulatory surgical center (ASC) procedure prior to the administration of anesthesia. Physicians should not use this modifier. This is only appropriate for use by the ASC.
What is a 55 modifier used for?
Postoperative management only. Use this modifier to indicate that payment for the postoperative, post-discharge care is split between two or more physicians where the physicians agree on the transfer of postoperative care.
What is 57 modifier?
CPT modifier 57 may be used to report the decision for surgery for certain codes. This modifier may be used to indicate that an evaluation and management (E/M) service performed on the same day or the day before a major surgery (090 global days) by the surgeon resulted in the decision to perform the procedure.
What is the difference between modifier 52 and 73?
Modifier 73 and modifier 74 are for facility use only and are used to report discontinued outpatient hospital/ASC procedures. Modifier 52 is used to indicate partial reduction, cancellation, or discontinuation of services and may be used for facility charges when anesthesia is not planned.
What is a 54 modifier?
Modifier 54
When a physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding this modifier to the usual procedure code.
What is the difference between modifier 52 and 53?
Know your choices: You might use modifier 52 (Reduced services), or modifier 53 (Discontinued procedure), or you might use a different code that accurately describes the work completed.
Does modifier 52 reduce payment?
Append modifier to the reduced procedure's CPT code. Ambulatory surgical centers (ASC) use modifier 52 to indicate the discontinuance of a procedure not requiring anesthesia. Contractors apply a 50 percent payment reduction for discontinued radiology and other procedures not requiring anesthesia.
Which modifier should be listed first?
In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second. The distinction between the two is simple: you always want to list the modifiers that most directly affect the reimbursement process first.
Does 99213 need a modifier?
Modifiers may be necessary for CPT code 99213 under certain circumstances, such as when billing for telehealth services or when other procedures are performed on the same day (e.g. Modifier 25). The specific modifier depends on the situation and payer requirements.