Discontinued Procedure (Modifier 53) reimbursement
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Defines billing and reimbursement rules for procedures reported with Modifier 53 (discontinued procedures) on CMS-1500 or equivalent claims for Florida Blue members and providers.
Effective 08/01/2026, reimbursement of discontinued procedures with Modifier 53 is 25% of the allowable amount for the primary unmodified procedure.
Coverage Criteria
Modifier 53 coverage rules
When Modifier 53 is appropriately reported:
Exceptions
Coding and Reimbursement
| 53 | Discontinued Procedure |
Provider Billing Actions
When to report Modifier 53 (Discontinued Procedure)
Append Modifier 53 on the claim when a procedure was started but discontinued before completion due to extenuating circumstances or threats to the patient’s well‑being; do not use Modifier 53 to report elective cancellations prior to anesthesia induction and/or surgical preparation in the operating suite.
- Report Modifier 53 on CMS-1500 or equivalent claim forms.
- Do not use Modifier 53 for elective cancellations prior to anesthesia induction or surgical preparation; see Reduced Services Policy (10-031) for procedures partially reduced or eliminated at the physician’s direction.
Definitions
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