(2023) Modifier 51 | Description & Billing Guidelines

This article outlines the description of modifier 51, the appropriate usage, and the inappropriate usage of modifier 51.

Description Of Modifier 51

Modifier 51 designates multiple procedures rendered at the same operative session or on the same day.

The 51 modifier (multiple procedures) must 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 support the appropriate use of Modifier 51 (multiple procedures).

Appropriate Usage For Modifier 51

The Medicare Physician Fee Schedule Database (MPFSDB) assigned indicators for the appropriate usage of the 51 modifier.

List Of Indicators

The below Indicator indicates which payment adjustment rule for multiple procedures applies to the service.

Indicator 0 (Multiple Surgery)

No payment adjustment rules for multiple procedures apply. If the 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.

Indicator 1 (Multiple Surgery)

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.

Indicator 2 (Multiple Surgery)

Standard payment adjustment rules for multiple procedures apply. If the 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.

Indicator 3 (Multiple Surgery)

Special rules for multiple endoscopic procedures apply if the procedure is billed with another endoscopy in the same family (i.e., another endoscopy with 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.

Indicator 4 (Multiple Surgery)

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

Indicator 5 (Multiple Surgery)

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

Indicator 6 (Multiple Surgery)

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

Indicator 7 (Multiple Surgery)

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 the same day. (Ophthalmology services)

Indicator 9 (Multiple Surgery)

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

Inappropriate Usage Of Modifier 51

• 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 (e.g., vaccines).
• Appending Modifier 51 to a CPT 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 describe the reported scenario accurately.

Return to List of All Modifiers