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Printed Date: 9/22/2015
"Surgical procedures" with the CPT modifier 52 appended requires a complete operative report and a concise statement explaining the nature of the reduced service.
"Non-surgical procedures" with the CPT modifier 52 appended requires a concise statement explaining how the service differs from the usual. This statement will only be accepted in the electronic documentation record and Block 19 of the 1500 form only.
Failure to include the documentation in the appropriate format will result in claims being rejected as "unprocessable" and must be resubmitted as new claims.
Special Note for Ophthalmology:
Special Note for Ambulatory Surgical Centers (ASCs): Effective for dates of service on or after January 1, 2008, report this modifier for discontinued radiology procedures and other procedures that do not require anesthesia. Other multiple procedure price reductions will not apply when this modifier is submitted by ASCs. Refer to CPT modifiers 73 and 74 for other discontinued procedures.
Special Note for Radiology:
NON-SURGICAL PROCEDURES — Documentation required for non-surgical procedures not mentioned above:
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Last Updated: 05/03/2019