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00731  Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified ...

Modifier 51 Multiple Procedures


Modifier 51 designates multiple procedures that are rendered at the same operative session or on the same day. Modifier -51 (multiple procedures) must be used to indicate instances when multiple procedures, other than E/M services, physical medicine and rehabilitation services, or provision of supplies (e.g., vaccines), are performed at the same session by the same provider.

The medical records must clearly support the appropriate use of Modifier 51 (multiple procedures).

The Medicare Physician Fee Schedule Database (MPFSDB) assigned indicators for the appropriate usage of Modifier 51. The below Indicator indicates which payment adjustment rule for multiple procedures applies to the service.

Multiple Surgery Indicator '0'

No payment adjustment rules for multiple procedures apply. If procedure is reported on the same day as another procedure, base payment on the lower of: (a) the actual charge or (b) the fee schedule amount for the procedure.

Multiple Surgery Indicator '1'

Standard payment adjustment rules in effect before January 1, 1996, or multiple procedures apply. In the 1996 MPFSDB, this indicator only applies to codes with procedure status of “D.” If a procedure is reported on the same day as another procedure with an indicator of 1,2, or 3, rank the procedures by fee schedule amount and apply the appropriate reduction to this code (100 percent, 50 percent, 25 percent, 25 percent, 25 percent, and by report). Base payment on the lower of: (a) the actual charge or (b) the fee schedule amount reduced by the appropriate percentage.

Multiple Surgery Indicator '2'

Standard payment adjustment rules for multiple procedures apply. If procedure is reported on the same day as another procedure with an indicator of 1, 2, or 3, rank the procedures by fee schedule amount and apply the appropriate reduction to this code (100 percent, 50 percent, 50 percent, 50 percent, 50 percent, and by report). Base payment on the lower of: (a) the actual charge or (b) the fee schedule amount reduced by the appropriate percentage.

Multiple Surgery Indicator '3'

Special rules for multiple endoscopic procedures apply if procedure is billed with another endoscopy in the same family (i.e.,another endoscopy that has the same base procedure). The base procedure for each code with this indicator is identified in field 31G. Apply the multiple endoscopy rules to a family before ranking the family with other procedures performed on the same day (for example, if multiple endoscopies in the same family are reported on the same day as endoscopies in another family or on the same day as a non-endoscopic procedure).

If an endoscopic procedure is reported with only its base procedure, do not pay separately for the base procedure. Payment for the base procedure is included in the payment for the other endoscopy.

Multiple Surgery Indicator '4'

Subject to 25% reduction of the TC diagnostic imaging (effective for services on or after January 1, 2006 through June 30, 2010).

Subject to 50% reduction of the TC diagnostic imaging (effective for services July 1, 2010 and after).

Subject to 25% reduction of the professional component (26 modifier) diagnostic imaging (effective for services January 1, 2012 and after).

Multiple Surgery Indicator '5'

Subject to 20% reduction of the practice expense component for certain therapy services (effective for services January 1, 2011 and after).

Multiple Surgery Indicator '6'

Subject to 25% reduction for subsequent TC services furnished by same physician (or by multiple physicians in same group practice, i.e., same Group NPI) to same patient on same day. (Cardiovascular Services)

Multiple Surgery Indicator '7'

Subject to 20% reduction for subsequent TC services furnished by same physician (or by multiple physicians in same group practice, i.e., same Group NPI) to same patient on same day. (Ophthalmology services)

Multiple Surgery Indicator '9'

Concept does not apply. Do not submit these procedures with CPT modifier 51

Inappropriate Usage

Modifier 51 appended to designated “add-on” codes.

Reporting on primary procedures and on base endoscopy procedures

Reporting to Evaluation and Management (E&M) CPT codes

Reporting to Physical Medicine and Rehabilitation services or provision of supplies (eg.vaccines)

Appending Modifier 51 to a CPT-4 designated Modifier 51 Exempt procedure code

Appending Modifier 51 to procedures that are considered components of the primary procedure

Appending Modifier 51 in instances when two or more physicians each perform distinctly different, unrelated surgeries on the same day for the same individual

Appending Modifier 51 when a more appropriate modifier exists to more accurately describe the scenario being reported.


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