Modifier -51 Exempt

POLICY NUMBER

None

DESCRIPTION

None

POLICY

Modifier -51 (multiple procedures) should be used to indicate instances when multiple procedures, other than E/M services, physical medicine and rehabilitation services, or provision of supplies (eg, vaccines), are performed at the same session by the same provider, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). NOTE: This code should not be appended to designated add-on codes (see Appendix D) nor modifier -51 exempt codes (Appendix E).

BCBSMS applies multiple surgery only to codes that fall under all of the following criteria:

• Codes that are 

  not

  add-on codes,

• Codes that are

  not

  modifier -51 exempt and

• Codes that are surgical procedures

CPT® made changes effective 1/1/2008 to the modifier -51 exempt code list by removing several codes that were listed as modifier -51 exempt and placed them into non-exempt status or as an add-on code.

Due to this change, the following fourteen (14) surgical codes that are no longer modifier -51 exempt will now be subject to multiple surgery reduction. These codes are 20660, 20690, 20692, 20900, 20902, 20920, 20922, 20924, 20926, 38792, 61210, and 62284.

Modifier -51 should be appended to these and any other surgical code(s) when multiple surgical procedures are performed at the same session by the same provider as applicable.

POLICY EXCEPTIONS

None

POLICY GUIDELINES

The coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.

POLICY HISTORY

1/2008: Policy written.

SOURCE(S)

None

CODE REFERENCE

None