Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
August, 2021
Modifier 57 – Decision for Surgery
Added the third paragraph in the policy statement to identify how the minor and major surgery codes are identified and provided a link to the CMS National Physician Fee Schedule.
Modifier 63 – Procedure Performed on Infants Less than 4 kg.
Revised the first paragraph in policy section by adding reference to the increased work and complexity of the service rendered by the provider. Added paragraph at the end of the policy section to indicate that the patient's medical records need to be
documented as to the need for the significantly greater effort required for the procedure and the reasons for the additional work.
Modifier 66 – Surgical Team
Clarified that a surgical team consists of three or more surgeons and how each team member needs to bill their services with modifier 66. Added a paragraph to indicate which of the global surgery flags will be reimbursed when appended to an appropriate
procedure code.
Modifier 73 – Discontinued ASC Procedure Prior to Administration of Anesthesia
Clarified in the first paragraph that modifier 73 is applicable to surgical procedures that require anesthesia. Identified the different kinds of anesthesia that could be performed. Added additional information on documentation in the patient's medical
record needed to support the use of modifier 73.
Modifier 74 – Discontinued ASC Procedure after Administration of Anesthesia
Clarified in the first paragraph that modifier 74 is applicable to surgical procedures that require anesthesia. Identified the different kinds of anesthesia that could be performed. Added additional information on documentation in the patient's medical
record needed to support the use of modifier 74.
Modifier 76 – Repeat Procedure by the Same Provider
Clarified in the policy section that modifier 76 isn't valid on pathology/laboratory and proprietary lab analysis codes.
Modifier 77 – Repeat Procedure by Another Provider
Annual review; no changes.
Modifier TH – Obstetrical treatment/service
Added the last paragraph in the policy statement indicating that the provider who bills services with modifier TH can't be the same provider who bills a global maternity care code. Updated code descriptions for new and established office visits to reflect
2021 code revisions. Global maternity care codes added to the coding guideline section of the policy.
Multiple Deliveries/Births
Added clarification in the policy section that each multiple birth should be billed on a separate claim line with modifier 59. Added last paragraph in the policy section to indicate that the diagnosis billed to indicate the outcome of the delivery should
reflect a multiple birth diagnosis code. Added multiple birth diagnosis codes to the coding guideline section.
Multiple Surgical Reductions
Annual review, no changes.