CurrentAnthemPolicy C-21004

Multiple Surgery - Facility

Facility reimbursement rules for multiple procedures performed during the same day/session at the same place of treatment; governs how Anthem calculates facility payment when more than one procedure is performed.

Policy Summary

PayerAnthem

PolicyMultiple Surgery - Facility

Policy CodePolicy C-21004

Change TypeNo material clinical changes; reviewed and reapproved

Effective Date01/01/2026

Next Review Date

Key ActionReimburse only the primary/highest valued procedure when multiple procedures are performed the same day/session/place; do not append Modifier 51 on facility claims.

SourceLink

POLICY UPDATE CHANGES

Revision effective 11/23/2022 removed all bilateral language and updated policy name to Multiple Surgery - Facility.

Review approved 10/01/2025 and effective 01/01/2026 with no changes.

1primary/highest valued procedure reimbursed when multiple performed

Modifier 51 not allowedmodifier guidance

C-21004identifier

2026-01-01effective date

Multiple Procedure Reimbursement Criteria

Facility reimbursement rules for multiple procedures:

Reimbursement is allowed for only the primary, or highest valued, procedure when multiple procedures are performed on the same day or same session, and at the same place of treatment.

Modifier 51 should not be appended to facility claims.

A single surgical procedure is subject to multiple procedure reduction guidelines when submitted with multiple units.

Standard Correct Coding applies.

Coding and Modifier Guidance

Modifier guidanceModifierNot Covered

Modifier 51

Multiple Procedures - not appropriate on facility claims; appropriate for professional claims to identify additional procedures

Policy Summary

PayerAnthem

PolicyMultiple Surgery - Facility

Policy CodePolicy C-21004

Change TypeNo material clinical changes; reviewed and reapproved

Effective Date01/01/2026

Next Review Date

Key ActionReimburse only the primary/highest valued procedure when multiple procedures are performed the same day/session/place; do not append Modifier 51 on facility claims.

SourceLink

On This Page

Definitions — Multiple Procedures and Surgeries

Modifier 51 / Multiple Procedures

DefinitionWhen multiple procedures (other than E/M, Physical Medicine and Rehabilitation services, or supplies) are performed at the same session by the same individual, the primary procedure may be reported and additional procedures may be identified by appending modifier 51.

Appropriate claim typeModifier 51 is only appropriate for professional claims and is not appropriate for facility claims.

Add-on codesModifier 51 should not be appended to designated 'add-on' codes (see Appendix F).

Multiple surgeries

DefinitionDistinct surgical procedures performed by a provider on the same patient during the same operative session.

Payment treatmentFacility reimbursement follows the multiple procedure rule: only the primary/highest valued procedure is reimbursed when multiple procedures occur same session/place.

Coding guidanceStandard Correct Coding applies; multiple procedure reduction guidelines may apply when multiple units are submitted.

OpenPayer

Multiple Surgery - Facility

Multiple Procedure Reimbursement Criteria

Coding and Modifier Guidance

Authorization and Medical Necessity

Definitions — Multiple Procedures and Surgeries