Modifier 52 – Reduced Services

*  Surgical Procedures: An operative report and a concise statement on how the service performed differs from the usual.

*  Non-Surgical Procedures: Provide a concise statement on how the service performed differs from the usual in the comment field of the electronic claim; a separate attachment is not required.
Note: If a statement explaining the reduction of the service or procedure is not submitted with the surgical or non-surgical procedure, the code billed with the 52 modifier will be denied, even if we receive an operative report.

Modifier 53 – Discontinued Procedure

*  Surgical Procedures: An operative report is required.

* Non-Surgical Procedures: Provide a concise statement on how the service performed differs from the usual in the comment field of the electronic claim or Item 19 of the paper form.

Modifiers for Radiology Services

Modifiers -52 (Reduced Services), -59, -76, and -77, and the Level II modifiers apply to radiology services.

When a radiology procedure is reduced, the correct reporting is to code to the extent of the procedure performed. If no HCPCS code exists for the service that has been completed, report the intended HCPCS code with modifier -52 appended.

EXAMPLE: CPT code 71020 (Radiologic examination, chest, two views, frontal and lateral) is ordered. Only one frontal view is performed. CPT code 71010 (Radiologic examination, chest: single view, frontal) is reported. The service is not reported as CPT code 71020-52.