| Modifier | Description |
|---|---|
| 22 | Increased procedural services: When the work required to provide a service is substantially is greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time, technical difficulty of procedure, and severity of patient’s condition, physical and mental effort required). Note: This modifier should not be appended to an E/M service. It should only be reported with procedure codes that have a global period of 0, 10, or 90 days. |
| 50 | Bilateral procedure: Unless otherwise identified in the listings, bilateral procedures that are performed at the same operative session should be identified by adding the modifier 50 to the appropriate five-digit code. |
| 51 | Multiple procedures: When multiple procedures, other than E/M services, physical medicine and rehabilitation services or provision of supplies (e.g., vaccines), are performed at the same session by the same provider, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending the modifier 51 to the additional procedure or service code(s). Note: This modifier should not be appended to designated "add-on" codes. |
| 52 | Reduced services: Under certain circumstances a service or procedure is partially reduced or eliminated at the physician’s discretion. Under these circumstances the service provided can be identified by its usual procedure number and the addition of the modifier 52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service. |
| 53 | Discontinued procedure: Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well-being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding the modifier 53 to the code reported by the physician for the discontinued procedure. Modifier 53 is used for “unusual (discontinued) circumstances”. Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure due to extenuating circumstances that may threaten the well-being of the patient. In many instances, attachments, medical records, etc. are not required to be sent in if an explanation for the discontinuation is in the narrative field of the claim. For example, submit “discontinued due to elevated blood pressure”. When additional information to support the use of the 53 modifier cannot be contained in the narrative of the claim, additional documentation may be submitted. |
| 62 | Two surgeons: When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. |
| 66 | Surgical team: Under some circumstances, highly complex procedures (requiring the concomitant services of several physicians, often of different specialties, plus other highly skilled, specialty trained personnel and various types of complex equipment) are carried out under the "surgical team" concept. Such circumstances may be identified by each participating physician with the addition of the modifier 66 to the basic procedure number used for reporting services. Documentation establishing that a surgical team was medically necessary is required for certain services identified by CMS. All claims for team surgeons must contain sufficient information i.e., operative reports, to allow pricing "by report". |
| 73 | Discontinued out-patient hospital/ ASC procedure prior to the administration of anesthesia. Due to extenuating circumstances or threaten patient well-being: Prior to procedure started/patient's surgical preparation (including sedation or taken to procedure room) Prior to administration of anesthesia (local, regional block or general). For physician reporting of a discontinued procedure, see modifier 53. |
| 74 | Discontinued out-patient hospital/ASC procedure after administration of anesthesia: Due to extenuating circumstances, or those that threaten the well-being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s) or general) or after the procedure was started (incision made, intubation started, scope inserted, etc.). Under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of the modifier 74. Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53. |
| PA | Surgical or otherwise invasive procedure on the wrong body part. Append the surgical or invasive procedure code performed incorrect body part. Note: CMS does not pay for service performed on the wrong part. |
| PB | Surgical or otherwise invasive procedure on the wrong patient. Append the surgical or invasive procedure code performed on the incorrect patient Note: CMS does not pay for service performed on the incorrect patient. |
| PC | Wrong surgery or other invasive procedure on patient. Append the surgical or invasive procedure code performed on the patient, when it was not the correct patient Note: CMS does not pay for an incorrect service performed on a patient. |