CPT modifier for reduced services. Under certain circumstances a service or procedure is partially reduced or eliminated at the physician’s election. 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. This modifier affects reimbursement, but there will be no effect on the physician’s fee profile in the computer data. It is not necessary to attach a report to the claim when using this modifier because it indicates a reduced fee. When a physician performs a procedure but does not charge for the service such as a postoperative follow-up visit that is included in a global service, remember to use code 99024. Some physicians prefer to bill the insurance carrier the full amount and accept what the carrier pays as payment in full. In such cases, a modifier would not be used. If only part of a procedure is performed and the physician feels a reduction in the service is warranted, to develop a reduced fee, try calculating the reduced service by time. Calculate the amount (cost) per minute of the complete procedure by dividing the amount (cost) by the usual time it takes to complete the procedure. To determine how long the reduced procedure took, multiply the amount (cost) per minute by the time it took to do the reduced procedure.

CPT modifier used for 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 for the discontinued procedure. This modifier is not used to report the elective cancellation of a procedure before the patient’s anesthesia induction and/or surgical preparation in the operating suite. For outpatient hospital/ambulatory surgery center (ACS), see modifier -73 and modifier -74 .

CPT modifier used for surgical care only: When one physician performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding the modifier -54 to the usual procedure number. This modifier may affect reimbursement. Because many surgical procedures encompass a “package” concept that includes normal uncomplicated follow-up care, the surgeon will be paid a reduced fee when using this modifier.

CPT modifier used for postoperative management only. When one physician performs the postoperative management and another physician performs the surgical procedure, the postoperative component may be identified by adding the modifier -55 to the usual procedure number. The fee to list would be approximately 30% of the surgeon’s fee.

CPT modifier used for preoperative management only. When one physician performs the preoperative care and evaluation and another physician performs the surgical procedure, the preoperative component may be identified by adding the modifier -56 to the usual procedure number. This modifier may affect reimbursement, depending on the payer.

CPT modifier used for decision for surgery. An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding the modifier -57 to the appropriate level of E/M service. This modifier is informational in nature. Do not ask for an adjustment in reimbursement. Monitor reimbursement when using this modifier.

CPT modifier used for staged or related procedure or service by the same physician during the postoperative period. The physician may need to indicate that the performance of a procedure or service during the postoperative period was (1) planned prospectively at the time of the original procedure (staged); (2) more extensive than the original procedure; or (3) for therapy after a diagnostic surgical procedure. This circumstance may be reported by adding the modifier -58 to the staged or related procedure. This modifier is informational in nature. Do not ask for an adjustment in reimbursement. Monitor reimbursement when using this modifier.This modifier is not used to report the treatment of a problem that requires a return to the operating room. See modifier -78 .

CPT modifier used for distinct procedural service. Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier -59 is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate, it should be used rather than modifier -59. Only if no more descriptive modifier is available, and the use of modifier -59 best explains the circumstances, should modifier -59 be used.

CPT modifier used for two surgeons. When two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure, each surgeon should report his or her distinct operative work using the same procedure code and adding the modifier -62. If additional procedures (including add-on procedures) are performed during the same surgical session, separate codes may be reported without the modifier -62. If the cosurgeon assists in the performance of additional procedure(s) during the same surgical session, those services may be reported using separate procedure code(s) with modifier -80 or -81.

CPT modifier used for procedure performed on infants less than 4 kg. Procedures performed on neonates and infants up to a present body weight of 4 kg may involve significantly increased complexity and physician work commonly associated with these patients. This circumstance may be reported by adding the modifier -63 to the procedure number. Unless otherwise designated, this modifier may only be appended to procedures/services listed in the 20000-69999 code series. Modifier -63 should not be appended to any codes listed in the Evaluation and Management Services, Anesthesia, Radiology, Pathology/Laboratory, or Medicine sections.