Effective November 16, 2011, services appended with Modifier 52 will be reimbursed at 50 percent of the provider?s applicable contracted rate. Modifier 52 is used to describe circumstances in which services provided are reduced, performed at a lesser level, or the provider has elected to eliminate the procedure altogether.

This information will be reflected in Claim Payment Policy #03.00.32: Modifier 52 Reduced Services. The policy notification has been available on our website for review by providers and their office staff since it was posted on August 18, 2011. This version of the policy will become effective November 16, 2011. Policy notifications are available on our medical policy website at www.amerihealth.com/medpolicy by entering the policy number in the Search box. If you have questions regarding this policy, please contact your Network Coordinator or Hospital/Ancillary Services Coordinator.