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Effective October 1, 2016, Modifier 53: Discontinued Procedure can
be reported when a professional provider or other qualified health care
professional terminates a procedure (e.g., surgical or diagnostic) due to
extenuating circumstances that may threaten the health of a patient. When
Modifier 53 is appended to a procedure, the service(s) is eligible for
reimbursement at 50 percent of the provider's applicable contracted rate.
Independence created the following policies, which were posted as
Notifications on July 1, 2016, to address the use of Modifier 53:
- Commercial: #03.00.33: Modifier 53: Discontinued Procedure
- Medicare Advantage: #MA03.018: Modifier 53: Discontinued
Procedure
Note: These policies apply to professional providers who bill on a
CMS-1500 claim form or the electronic equivalent, 837P, for all Independence
members.
To view the Notifications for these policies, visit our Medical Policy Portal
and select Accept and Go to Medical Policy Online. Then select either
Commercial or Medicare Advantage under Active Notifications.
If you have any questions, please contact your Network Coordinator.
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