CPT modifier used for anesthesia by surgeon. Regional or general anesthesia provided by the surgeon may be reported by adding the modifier -47 to the basic service (this does not include local anesthesia). This modifier may affect reimbursement, depending on the payer. Modifier -47 would not be used for anesthesia procedures 00100 through 01999.

CPT modifier used for a bilateral procedure. Unless otherwise identified in the listings, bilateral procedures requiring a separate incision performed during the same operative session should be identified by the appropriate five-digit code describing the first procedure. The second (bilateral) procedure is identified by adding modifier -50 to the procedure number. It is important to read each surgical description carefully to look for the word “bilateral.” A bilateral modifier on a unilateral procedure code indicates that the procedure was performed on both sides of a paired organ during the same operative session.

CPT modifier used for multiple procedures. When multiple procedures, other than E/M services, 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 adding the modifier -51 to the additional procedure or service code(s). This modifier should not be appended to designated “add-on” codes (see Appendix E of CPT). Always list the procedure of highest dollar value first.

Symbol used in the procedure code book titled Current Procedural Terminology (CPT) to indicate a procedure code listed is exempt from the use of modifier -51 but have not been designated as CPT add-on procedures/services. A summary of five-digit procedural codes exempt from modifier -51 are shown in Appendix E in CPT.

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.