We, at Novitas, have seen claims reporting modifier 52 (reduced services) without supporting documentation or an explanation in the narrative of the claim.
In order to help you avoid claim denials and future appeals due to these incorrect submissions, we are providing guidance on how to properly submit a claim when applying this modifier.
Your remittance advice will have the following 3 messages tied to the service:
Information requested from the billing / rendering provider was not provided or not provided timely or was insufficient / incomplete. At least one remark code must be provided (may be comprised of either the NCPDP reject reason code, or remittance advice remark code that is not an Alert).
Incomplete/invalid documentation.
Missing documentation.
Under certain circumstances a service or procedure is partially reduced or eliminated at the provider's discretion.
Unusual (reduced) circumstances.
The service performed was significantly less than usually required.
To indicate partial reduction of services for which anesthesia is not planned.
Append modifier to the reduced procedure’s CPT code.
Ambulatory surgical centers (ASC) use modifier 52 to indicate the discontinuance of a procedure not requiring anesthesia.
Contractors apply a 50 percent payment reduction for discontinued radiology and other procedures not requiring anesthesia.
ASC services billed with modifier -52 modifier are not subject to the multiple procedure reduction.
To report the termination of a procedure.
Do not use on time-based codes.
When used on evaluation and management services.
Additional information to support the modifier can be written in the narrative of claim
Supporting documentation should:
State when the procedure was started.
Explain why the procedure was discontinued.
Notate the percentage of the procedure that was performed.
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