Modifier Codes 52 and 53

Modifier Code 52

This is used to identify a procedure that is less extensive than the CPT description indicates. This modifier is used when a procedure is begun, but cannot be completed. For example, a physician may attempt to excise a vascular malformation, but be unable to complete the excision due to entrapment of other structures.

This should only be used when the complete procedure could not be done. It should not be used to represent a reduction in the physician's fees due to other factors.

Modifier Code 53

Modifier code 53 is used to identify a surgical procedure that has been discontinued due to circumstances that threaten the well being of the patient. This modifier is used when a procedure is begun but cannot be completed. For example, early in the course of an abdominal surgery, the patient suffers cardiac arrest and the surgery must be discontinued.

Notes on Modifier Codes 52 and 53

• Please attach an operative report when submitting claims billed with modifier 53. The operative report will allow the medical director to review the services provided and determine the appropriate reimbursement. Claims submitted without an operative report will be denied with a request to submit the additional information
• Modifier codes 52 and 53 should not be used if a procedure is cancelled prior to the induction of anesthesia and/or surgical preparation in the operating suite. In such a case the procedure should not be billed.

Revision History