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Posted By Maria on 04-16-2019, 14:54:40 in Ob-Gyn
Melanie,

I know CMS has determined that modifier 51 is no longer needed for multiple procedures.

Matter of fact, I think they prefer modifier 51 not to be used.

Their software automatically makes the necessary adjustments.

I realize other payers maybe different, but Medicare is the standard and most bigger payers usually follow their guidelines.

Does modifier 51 actually drive the multiple procedure reduction , or is it Multiple Surgery Indicator on the used CPT codes listed in the Physician Fee Schedule Database? 1,2,3

Their seem to be much confusion on modifier 51 here, stating that is the only way they can determine the RVUs and the reduction is if the coder attaches the modifier 51.

Thus causing provider payment issues as they are paid based on their work RVUs.

This does not seem right to me.

Your opinion please?

Thanks, Maria







Comments (1)
Posted By Melanie Witt on 04-18-2019, 21:50:40
As you say, Medicare no longer requires the -51 because if a second code appears on the claim, they will reduce it according to the multiple surgery indicator. Whether or no commercial insurance insurance does this as well, remains to be seen. But in most cases, I believe they do discount the second, third, fourth, etc. procedures whether -51 is used or not. The most important point here is to always list the code with the highest RVU first on the claim to ensure you get that one paid at 100%.
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