Policy Statement
CPT modifier 53 is valid only when a physician or other qualified health care professional elects to terminate a surgical or diagnostic procedure due to extenuating circumstances or situations that threaten the well-being of the patient.
CPT modifier 53 should be appended to only one code per operative session. Procedure codes for other procedures not performed at all should not be additionally reported.
CPT modifier 53 is not valid when used for elective cancellation of a procedure prior to anesthesia induction and/or surgical preparation in the operating suite.
CPT modifier 53 is not valid when a laparoscopic or endoscopic procedure is converted to an open procedure or when a procedure is changed or converted to a more extensive procedure. The open procedure or more extensive procedure should be reported.
CPT Modifier 53 is not valid with evaluation and management (E&M) or anesthesia codes.
CPT modifier 53 indicates a procedure was discontinued by a physician or other qualified health care professional and may not be reported by facilities.
Reimbursement for discontinued procedure with modifier 53 is 50% of the allowable amount. The reduction to 50% of the allowable amount will apply when modifier 53 is billed with other pricing modifiers, for example, a discontinued procedure performed by an assistant surgeon.
The fee reduction does not apply to codes with unique Relative Value Units (RVUs) for the modifier 53 combination, such as codes 44388-53, 45378-53, G0105-53 and G0121-53.
Procedure code/modifier combinations that are considered not valid for our health plans use will be denied.
For outpatient hospital or Ambulatory Surgery Center (ASC) reporting of discontinued services, see modifier 73 and 74.
References
Cross References
- Mod 116 - Modifiers 73 and 74; Discontinued Services
- Mod 109 - Modifiers 80, 81, 82 and AS; Assistant at Surgery
