Bienvenidos, Corredores!

Fidelis Care would like to remind providers of the appropriate coding modifiers to use when billing for a surgical or diagnostic procedure that was discontinued or stopped prior to completion for both facilities and physicians. 

Modifiers 73/74 are specifically used by facilities, to indicate that a procedure was discontinued or stopped prior to completion.  Coinciding with these facility modifiers, physicians should bill modifiers 52/53, which also indicates that a procedure was discontinued or cancelled.  If a procedure has been discontinued, both facility and physician claim submissions should reflect the discontinuation, by using the appropriate modifier codes below.

Facility Modifier Codes:

• Modifier 73: Discontinued outpatient or ambulatory surgery center procedure before anesthesia is administered.

• Modifier 74: Discontinued outpatient or ambulatory surgery center procedure after anesthesia is administered or after the procedure has started.

Physician Modifier Codes:

• Modifier 52: A service or procedure was partially reduced or eliminated at the provider's discretion or due to patient factors.

• Modifier 53: A procedure was terminated due to unforeseen circumstances or factors that threaten the patient's well-being, and the procedure was not completed.

Additional Resources:

• NYS Department of Health APG Modifiers
• AAPC Modifiers 52 and 53 vs. 73 and 74
• CMS Claims Processing Manual
• CMS Medicare Claims Processing

For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.