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New policies for Modifier 53: Discontinued Procedure

July 29, 2016

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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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