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CPT Modifier 51
Description:
Multiple procedures
Guidelines/Instructions:
- The CPT narrative associated with this modifier has changed, effective for dates of service on or after January, 1 2008
- Refer to the 'Mult Surg' indicator in the Medicare Physician Fee Schedule database (MPFSDB) to determine if CPT modifier 51 is applicable to a particular procedure code
- Note: We strongly recommend that you do not submit this modifier to Palmetto GBA. Palmetto GBA will apply this modifier to indicate when special pricing rules have been used to calculate the reimbursement, as described below
- This modifier may not be submitted with designated “add-on” codes (refer to Appendix D of the Current Procedural Terminology (CPT) 2010 for a list of add-on codes)
Steps:
- Access the database directly from the CMS Web site at www.cms.hhs.gov/PFSlookup/
- Select Physician Fee Schedule Search from the left area of the Web page
- Screen defaults to current year. Under Type of Information, select Payment Policy Indicators, then 'next'
- On the 'select field options' screen, select 'Next'
- Enter the procedure code and select 'All Modifiers', then click 'Submit'
- Refer to the column heading 'Mult Surg'
- Indicator 0: No payment adjustment rules for multiple procedures apply
- Indicator 1: Not used
- Indicator 2: Multiple procedure rules apply. If a procedure is reported on the same day as another procedure with an indicator of 2 or 3, the procedures are ranked by fee schedule amount from highest to lowest. Reimbursement for the procedure with the highest fee schedule amount is based on 100 percent of the fee schedule. Reimbursement for the 2nd through 5th procedures is based on 50 percent of the fee schedule amount. Reimbursement for the 6th and remaining procedures is determined on an individual basis, and operative reports are required with these claims. If the submitted charge is less than the fee schedule-based charge, reimbursement will be based on the submitted charge.
- Indicator 3: Special rules for multiple endoscopic procedures apply if the procedure is submitted with another endoscopy in the same family (i.e., another endoscopy that has the same base procedure). If multiple endoscopies are reported on the same day as other non-endoscopic surgical procedures, the multiple endoscopy rules are applied before other multiple procedure reductions. If an endoscopic procedure is reported with only its base procedure, Palmetto GBA will not make separate payment for the base endoscopy because payment for the base endoscopy is included in payment for the other endoscopy.
- Indicator 9: Concept does not apply
Reference:
- Complete definitions of multiple surgery indicators are available in CMS Pub. 100-04, chapter 23 (PDF, 1.28 MB) in the Addendum following section 90