Modifiers: CMS Says 'Use Modifier 51'--Some MACs Say 'Not So Fast'

Why This Topic Matters

Differences between CMS guidance and contractor workflow can affect claim submission practices, payer-specific billing policies, and how coders coordinate with Medicare and other insurers.

Article Sections

1. Use Modifier on ‘More Major’ Surgery

   This section summarizes CMS guidance on multiple procedures and the general Medicare context for surgical claims. It discusses the broad billing scenario addressed in the article and the role of modifier 51.

2. MACs Often See Things Differently

   This section describes how Medicare administrative contractors may differ from CMS guidance and emphasizes payer-specific policy review. It also covers the need to verify local requirements before submitting claims.