Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
May 20, 2021
Ambulatory Surgery Center (ASC) Facility Services: Modifier
SG and Place of Service 24
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Durable Medical
Equipment (DME) and Home Medical Equipment (HME)
Added payment policy modifier RA to the cross-reference section. Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic
claim form.
Modifier 22 – Increased
Procedural Services
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form. Added second paragraph in policy section to identify which codes can and cannot
be appended with modifier 22.
Modifier 52 – Reduced
Services
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Modifier 53 –
Discontinued Procedure
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.
Modifier 54, 55, 56 –
Surgical Care Only, Postoperative Management Only, Preoperative Management Only
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form. Inserted LINK to
the CMS National Physician Fee Schedule in the policy section.
Modifier 78 - Unplanned return to the
Operating Room by the Same Physician for a Related Procedure During Post-operative period
Added cross reference to modifier 76 payment policy. Clarified the purpose statement to indicate that the policy pertains to professional services billed
on a CMS-1500 or 837P electronic claim form. Added LINK to the National Physician Fee Schedule. Added paragraph referencing Modifier 76 for repeat of the same identical procedure.
Unlisted, Non-specific
and Miscellaneous Procedure Codes
Clarified the purpose statement to indicate that the policy pertains to professional services billed on a CMS-1500 or 837P electronic claim form.