Modifier 51: Indicates applicable payment adjustment rule for multiple procedures
Details
Multiple Surgery Rules 100% of MPFS amount is allowed for highest valued surgical procedure and 50% for additional surgical procedures (with a multiple surgery indicator of "2") performed same day. Modifier 51 will be appended to identify reduced services.
See also
Other PFS Helpers:
switch_assistant_surgery(),
switch_bilateral_surgery(),
switch_co_surgeon(),
switch_diagnostic_imaging(),
switch_global_days(),
switch_opps_indicator(),
switch_pctc_indicator(),
switch_status_description(),
switch_status_name(),
switch_supervision(),
switch_team_surgery()
Examples
switch_multiple_procedure(as.character(0:9))
#> [1] "No adjustment. If procedure is reported on the same day as another procedure, base the payment on the lower of (a) the actual charge, or (b) the fee schedule amount for the procedure."
#> [2] "Standard adjustment. If reported on the same day as another procedure with an indicator of 1, 2, or 3, rank the procedures by fee schedule amount and apply the appropriate reduction to this code (100%, 50%, 25%, 25%, 25%, and by report). Base payment on the lower of (a) the actual charge, or (b) the fee schedule amount reduced by the appropriate percentage."
#> [3] "Standard adjustment. If reported on the same day as another procedure with an indicator of 1, 2, or 3, rank the procedures by fee schedule amount and apply the appropriate reduction to this code (100%, 50%, 50%, 50%, 50% and by report). Base payment on the lower of (a) the actual charge, or (b) the fee schedule amount reduced by the appropriate percentage."
#> [4] "Special rules for multiple endoscopic procedures apply if procedure is billed with another endoscopy in the same family (i.e., another endoscopy that has the same base procedure). The base procedure for each code with this indicator is identified in the Endobase column. Apply the multiple endoscopy rules to a family before ranking the family with the other procedures performed on the same day (for example, if multiple endoscopies in the same family are reported on the same day as endoscopies in another family or on the same day as a non-endoscopic procedure). If an endoscopic procedure is reported with only its base procedure, do not pay separately for the base procedure. Payment for the base procedure is included in the payment for the other endoscopy."
#> [5] "Special rules for the technical component (TC) of diagnostic imaging procedures apply if procedure is billed with another diagnostic imaging procedure in the same family (per the diagnostic imaging family indicator, below). If procedure is reported in the same session on the same day as another procedure with the same family indicator, rank the procedures by fee schedule amount for the TC. Pay 100% for the highest priced procedure, and 50% for each subsequent procedure. Base the payment for subsequent procedures on the lower of (a) the actual charge, or (b) the fee schedule amount reduced by the appropriate percentage. Subject to 50% reduction of the TC diagnostic imaging (effective for services July 1, 2010 and after). Subject to 25% reduction of the PC of diagnostic imaging (effective for services January 1, 2012 through December 31, 2016). Subject to 5% reduction of the PC of diagnostic imaging (effective for services January 1, 2017 and after)."
#> [6] "Subject to 50% of the practice expense component for certain therapy services."
#> [7] "Subject to 25% reduction of the second highest and subsequent procedures to the TC of diagnostic cardiovascular services, effective for services January 1, 2013, and thereafter."
#> [8] "Subject to 20% reduction of the second highest and subsequent procedures to the TC of diagnostic ophthalmology services, effective for services January 1, 2013, and thereafter."
#> [9] NA
#> [10] "Concept does not apply"