CurrentBlue Cross Blue Shield - MainePolicy C-21004

Multiple Surgery - Facility

Defines facility reimbursement rules when multiple procedures are performed during the same session or day, and guidance for billing and coding for facility providers under Blue Cross Blue Shield - Maine.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyMultiple Surgery - Facility

Policy CodePolicy C-21004

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review Date

Key ActionServices must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

primary procedure onlyfacility reimbursement allowed for

Modifier 51 prohibited on facility claimsmodifier guidance

no changes10/01/2025 review note

CMS & EncoderProsources considered

Facility Multiple Procedure Coverage

Multiple procedure facility coverage

Facility reimbursement rules for multiple procedures

When multiple procedures are performed on the same day/session and at the same place of treatment, reimbursement is allowed for only the primary (highest valued) procedure.

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; provider, state, or federal contracts and requirements take precedence over this reimbursement policy.

Billing, Modifiers, and Coding Requirements

Modifier guidanceModifier

Modifier 51

Should not be appended to facility claims; appropriate only for professional claims for additional procedures

Coding requirementsmixed

CPT/HCPCS/Revenue codes

Services should be billed with CPT, HCPCS and/or revenue codes supported by medical record

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyMultiple Surgery - Facility

Policy CodePolicy C-21004

Change TypeNo material changes

Effective DateJan 1, 2026

Next Review Date

Key ActionServices must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Key Definitions

Modifier 51 / Multiple Procedures — definition

Definition - Modifier 51 / Multiple ProceduresWhen multiple procedures (other than E/M services, Physical Medicine and Rehabilitation services, or provision of supplies) are performed at the same session by the same individual, the primary procedure may be reported as listed and additional procedures may be identified by appending modifier 51 to the additional procedure codes; modifier 51 is appropriate only for professional claims.

Not for add-on codesModifier 51 should not be appended to designated add-on codes.

Not for facility claimsThis modifier should not be appended to facility claims (modifier 51 is only appropriate for professional claims).

Context noteExample exclusions include E/M services, PM&R services, and supplies (eg, vaccines).

Multiple surgeries — definition

Definition - Multiple surgeriesDistinct surgical procedures performed by a provider on the same patient during the same operative session.

Same operative sessionApplies when multiple distinct surgeries occur during the same operative session by the same provider.

Reimbursement implicationMultiple surgeries are subject to the facility multiple-procedure reimbursement rules (only primary procedure reimbursed per policy).

OpenPayer

Multiple Surgery - Facility

Facility Multiple Procedure Coverage

Billing, Modifiers, and Coding Requirements

Authorization and Medical Necessity

Key Definitions