What is Modifier 51 in Healthcare Billing? | Healthcare and Technology news | Scoop.it

In Medical Billing there is a great deal of Medical Billing Terminology that can be intimidating to deal with when first getting started.

One important term that you must be familiar with is the Modifier 51, sometimes used in conjunction with Multiple Procedure Payment Reduction (MPPR) claims.

Modifier 51 (which specifically denotes multiple procedures) is used to inform payers that two or more procedures are being reported on the same day.

A claim form (also known as a CMS 1500 form) that has Modifier 51 appended to a CPT code(s) tells the insurance payer to apply the multiple procedure payment formula to the CPT code(s) linked to the Modifier 51, assuming the payer accepts this modifier.

It is important to note that Medicare does not recommend reporting Modifier 51 on your claim; the processing system has hard-coded logic to append the modifier to the correct procedure code.

Before doing any physician billing, it’s very important to understand MPPR.  Some insurance companies will tell physicians not to use the Modifier 51 when submitting their billing, as the payor will apply the discount, however many medical societies recommend that practices append the modifier anyway, making sure that it is appropriate.