tci Medicare Compliance & Reimbursement - 2016 Issue 7

Modifiers: Know When to Use Modifier 51 -- and When Not To

Navigate conflicting preferences with this expert advice. Be cautious when using modifier 51 (Multipleprocedures). While the Centers for Medicare & MedicaidServices (CMS) has excellent advice on how to use this modifier, other payers warn against using it on your Medicare claims. To navigate the variations between Medicare’s advice and your MACs’ preferences, you’ll have to cross-reference your payer policies with Medicare’s regulations. Use Modifier on ‘More Major’ Surgery Although many practices haven’t brushed up on their modifier 51 skills in years, CMS believed the topic was ripe for an education session. “Modifier 51...

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