Modifier 51 is defined as multiple surgeries/procedures.
Multiple surgeries performed on the same day, during the same surgical session.
Diagnostic Imaging Services subject to the Multiple Procedure Payment Reduction that are provided on the same day, during the same session by the same provider.
Note: Medicare doesn’t recommend reporting Modifier 51 on your claim; our processing system will append the modifier to the correct procedure code as appropriate.
Modifier is appended when:
The same physician performs more than one surgical service at the same session (Indicator 2).
The technical component of multiple diagnostic procedures, Multiple Procedure Payment Reduction (MPPR) rule applies (Indicator 4).
The multiple surgical procedures are done on same day but billed on two separate claims.
The surgical procedure code is the lower physician fee schedule amount.
The diagnostic imaging procedure with the lower technical component fee schedule amount.
Do not append to add-on codes (See Appendix D of the CPT manual)
Do not report on all lines of service
Do not append when two or more physicians each perform distinctly, different, unrelated surgeries on the same day to the same patient.
Medicare pays for multiple surgeries by ranking from the highest physician fee schedule amount to the lowest physician fee schedule amount.
100% of the highest physician fee schedule amount
50% of the physician fee schedule amount for each of the other codes
Medicare will forward the claim information showing Modifier 51 to the secondary insurance.
Multiple surgery pricing also applies to assistant at surgery services.
Multiple surgery pricing applies to bilateral services (modifier 50) performed on the same day with other procedures.