Author Topic: Medicare Adding 51 Modifier  (Read 1661 times)

davhafstehow

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Medicare Adding 51 Modifier
« on: May 22, 2013, 06:05:50 PM »
As of just recently, I've noticed that Medicare is adding the 51 modifier to multiple procedures on my claims.  Everything I've read tells me this is correct and that they have edits in place to add this modifier.  All of the information I've found implies this has been in place for quite some time.  Why all of a sudden are they adding this modifier?  It would be greatly appreciated if anyone had any information regarding this subject.  Thank you!
Tanya

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Re: Medicare Adding 51 Modifier
« Reply #1 on: May 23, 2013, 08:44:10 AM »
Hard to say why it's happening "all of a sudden" without more detail but if concerned I would call them to find out why.
I can only tell you that it's in CMS claims processing manual

Multiple procedures – When multiple procedures, other than evaluation and management services, are performed on the same day or 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 modifier ‘-51′ to the additional procedure or service code(s). MODIFIER 51 IS NOT REQUIRED FOR BILLING PURPOSES: The carrier will assign the multiple procedure modifier if appropriate based on the services billed.  PAYMENT RULES: We approve 100% of the fee schedule amount for the highest valued procedure, 50% for the 2nd-5th procedures and “by report” for subsequent procedures. Payment determined on a “by report” basis for these codes should never be lower than 50 percent of the full payment amount.EXCEPTIONS: Multiple endoscopies: Special rules for multiple endoscopic procedures apply if the procedure is billed with another endoscopy in the same family. See CMS Internet Only Manual, Pub. 100-04, Chapter 12, Section 40.6 for endoscopy rules.
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Merry

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Re: Medicare Adding 51 Modifier
« Reply #2 on: June 20, 2013, 09:19:16 PM »
Back in the "old days" we used that modifier. Then decided to let Medicare do it. Obviously they are..and as you know, your reimbursement will be reduced accordingly.