CurrentPremera BluecrossPolicy N/A

Modifier 53 — Discontinued Procedure

Defines when Premera recognizes Modifier 53 on professional claims to report surgical or diagnostic procedures that are discontinued after the procedure started or after induction of anesthesia, and explains documentation and alternative modifiers for ASC/outpatient facility services.

Policy Summary

PayerPremera Bluecross

PolicyModifier 53 — Discontinued Procedure

Policy CodePolicy N/A

Change TypeClarification and additions

Effective DateN/A

Next Review DateN/A

Key ActionDocument that the procedure was started, why it was discontinued, and at what point in the surgery it was discontinued; if no portion performed, do not bill.

SourceLink

POLICY UPDATE CHANGES

Specified that Modifier 53 applies when a procedure was terminated after induction of anesthesia (if the procedure requires anesthesia) or after the procedure was started.

Clarified that if no portion of the procedure was performed, the procedure should not be billed.

Added guidance that Modifier 52 should not be appended to professional claims to report a discontinued procedure and that modifier 52 is used for outpatient claims representing cancellations that do not require anesthesia.

Clarified that modifiers 73 and 74 are appropriate for discontinued ASC and outpatient facility services, not for professional services.

33%Reimbursement when modifier 53 appended

MultipleApplies to lines of business

AnnualPolicy review cadence

52,73,74Related modifiers

When Modifier 53 Is Recognized

Modifier 53 coverage criteria

Covered when ALL of the following are met:

Procedure must have been started or anesthesia induced (if the procedure requires anesthesia) and discontinued due to extenuating circumstances beyond the control of the physician or circumstances that may affect the life of the patient.

Medical record must document that the procedure was started, the reason the procedure was discontinued, and the point in the surgery at which it was discontinued.

If no portion of the procedure was performed, the procedure should not be billed.

Modifier 53 is valid for professional services only; it is not appropriate for elective cancellations prior to administration of anesthesia or surgical preparation, E&M codes, unlisted procedure codes, time‑based procedure codes, or when a more appropriate/lesser procedure code describes the portion completed.

Policy Summary

PayerPremera Bluecross

PolicyModifier 53 — Discontinued Procedure

Policy CodePolicy N/A

Change TypeClarification and additions

Effective DateN/A

Next Review DateN/A

Key ActionDocument that the procedure was started, why it was discontinued, and at what point in the surgery it was discontinued; if no portion performed, do not bill.

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.

Referenced Modifiers and Payment Adjustment

Modifiers referencedModifier

Modifier 53	Discontinued Procedure - professional service
Modifier 52	Reduced Services - use for discontinued outpatient facility services that do not require anesthesia; not for professional discontinued procedures
Modifier 73	Discontinued Outpatient Hospital/ASC Procedure Prior to Administration of Anesthesia
Modifier 74	Discontinued Outpatient Hospital/ASC Procedure After Administration of Anesthesia

Payment adjustment for Modifier 53

Payment adjustmentReimbursement for procedures appended with Modifier 53 will be adjusted to 33% of the provider's applicable fee schedule allowed amount.

ScopeApplies to professional claims submitted to Premera Blue Cross, Premera BCBS Alaska, LifeWise WA, LifeWise Assurance, and Premera HMO lines of business.

Exceptions & enforcementViolations may result in increased auditing, performance penalties, or contract termination as determined by the Plan.

Documentation and Adjudication Requirements

Documentation Required

Document procedure start, reason and surgical point of discontinuation; do not bill if no portion performed

Document that the procedure was started, the reason it was discontinued, and the point in the surgery when discontinuation occurred; if no portion of the procedure was performed, do not bill. Coverage and final payment are subject to member eligibility, benefit limits, the Plan's medical policy, and standard claims adjudication edits.

Medical record must document that the procedure was started, why it was discontinued, and at what point in the surgery the procedure was discontinued.
If no portion of the procedure was performed, the procedure should not be billed.
Coverage determined by member eligibility, benefit limits, and medical policy; final payment subject to claims adjudication edits and coding policies.

Modifier Definitions and Facility Guidance

Modifier 53 - Discontinued Procedure

DefinitionModifier 53 — Discontinued Procedure: appended to a professional service to indicate a surgical or diagnostic procedure was terminated after induction of anesthesia (if the procedure requires anesthesia) or after the procedure was started due to extenuating circumstances beyond provider control or affecting patient life.

Documentation requiredMedical record must document that the procedure was started, why it was discontinued, and at what point in the surgery it was discontinued.

Not billable if not performedIf no portion of the procedure was performed, the procedure should not be billed.

Modifier 52 - Reduced Services

Primary guidanceModifier 52 (Reduced Services) should not be appended to report a discontinued procedure for a professional claim.

Appropriate useUse modifier 52 for outpatient facility cancellations that do not require anesthesia to report reduced services or discontinued procedures in that setting.

DistinctionDo not use modifier 52 on professional claims for discontinued procedures; professional discontinued procedures are reported with Modifier 53 when applicable.

Modifiers 73 and 74 — Discontinued ASC/Outpatient Facility Procedures

Applicable settingModifiers 73 and 74 are appropriate for discontinued ASC and outpatient facility procedures, not for professional services.

Modifier 73Discontinued Outpatient Hospital/ASC Procedure Prior to Administration of Anesthesia — use for ASC/outpatient facility services discontinued before anesthesia is given.

Modifier 74Discontinued Outpatient Hospital/ASC Procedure After Administration of Anesthesia — use for ASC/outpatient facility services discontinued after anesthesia is given.