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Multiple Surgical Procedures

Description of Service

When a service involves multiple surgical procedures by the same professional provider, in the same setting, and on the same date of service, surgery reduction guidelines will apply.

Reimbursement Policy

Multiple surgical procedures (modifier 51): Procedures performed during the same operative session by the same provider are reimbursed at 100% of the regular, reasonable, and customary amount for the primary or first surgical procedure and 50% of the regular, reasonable, and customary amount for each secondary procedure.

Bilateral procedures (modifier 50): Procedures performed on both sides of the body during the same operative session are reimbursed at 100% of the regular, reasonable, and customary amount of the first surgical procedure and 50% of the regular, reasonable, and customary amount of the secondary procedure.

Exclusions: The above policy will not apply to procedures which are modifier 51 exempt based on AMA CPT Guidelines. The policy does not apply to procedures determined to be not medically necessary.

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