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.ibx.com/medpolicy
by entering the policy number in the Search box. If you have questions
regarding this policy, please contact your Network Coordinator.