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tci ED Coding & Reimbursement Alert - 2021 Issue Q2

Reader Question: Is Modifier 51 Required?

Question: We have a coder who puts modifier 51 (Multiple procedures) on almost all claims for procedures. We were told by our MAC that they’ll automatically apply it when required. Is this accurate or should we keep using it? Wisconsin Subscriber Answer: You should most likely stop using it, depending on which payers you’re billing. “Medicare does not recommend reporting Modifier 51 on your claim,” said Part B MAC WPS Medicare in its Modifier 51 Fact Sheet. “The processing system has hard-coded logic to append the modifier to the correct procedure code.” Here&rsquo...

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