Modifier 51 - Multiple Procedures
Defines how Premera recognizes and applies Modifier 51 on professional (CMS-1500/837P) claims and explains that multiple procedure reductions are determined by CMS NPFS multiple procedure indicator flags rather than the presence of modifier 51. Applies to Premera Blue Cross lines of business and affiliated plans.
No material clinical or coverage changes in this revision.
Modifier 51 Coverage and Payment Rules
Modifier 51 coverage and payment rules
Covered when ALL of the following are met:
ALL of the following
- When multiple procedures, other than Evaluation and Management (E&M), Physical Medicine and Rehabilitation services, or provision of supplies (e.g., vaccines) are performed in the same session by the same provider, the primary procedure should be reported as listed; additional procedures may be identified by appending modifier 51 to each additional procedure.
- The Plan does not use modifier 51 to determine multiple procedure reductions; multiple procedure reductions are determined by the CMS National Physician Fee Schedule (NPFS) multiple procedure indicator flag values (0,1,2,3,4,6,7,9) which invoke standard or special payment adjustment rules.
- No reimbursement adjustment is applied to Modifier 51; use of modifier 51 does not exempt services from multiple procedure reductions described in related Payment Policies.
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