Reduced and Discontinued Procedures
Payment and coding policy for procedures reported with modifiers 52 (reduced services) and 53 (discontinued procedures) for providers submitting UB-04 or CMS-1500 claims across WPS commercial lines.
No material clinical or coverage changes in this revision.
Reduced and Discontinued Procedure Coverage
Reduced and Discontinued Procedure Criteria
When to report and how reimbursement is applied:
Modifiers and Reimbursement
| Modifier 52 | Reduced services |
| Modifier 53 | Discontinued procedure |
Modifier Reporting and Restrictions
Report reduced services with Modifier 52 and discontinued procedures with Modifier 53; observe reporting restrictions
Report reduced services by appending Modifier 52 and discontinued procedures by appending Modifier 53, per CPT guidance; do not use these modifiers when a code exists that represents the completed portion of the intended procedure, for elective cancellations prior to anesthesia induction/IV conscious sedation/surgical preparation in the operating suite, or with evaluation and management (E/M) services. Modifier 53 is also not appropriate when a laparoscopic/endoscopic procedure is converted to an open procedure or when a procedure is changed to a more extensive procedure.
- Use Modifier 52 for partially reduced or eliminated services; not appropriate if a code exists for the completed portion. [[cite]]
- Use Modifier 53 for procedures started but discontinued; not appropriate if a code exists for the completed portion. [[cite]]
- Do not use Modifiers 52 or 53 for E/M services.
- Do not use Modifiers 52 or 53 for elective cancellations prior to anesthesia induction, IV conscious sedation, or surgical preparation in the operating suite.
- Do not use Modifier 53 when a laparoscopic/endoscopic procedure is converted to an open procedure or changed to a more extensive procedure.
Modifier Definitions
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