Per the Current Procedural Terminology (CPT®) book, under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. These services are represented by appending modifier 52.
Effective September 1, 2022, “reduced services” as indicated by modifier 52, will reduce payment by 50%.
This change will impact commercial lines of business only, including the State Health Plan (SHP).
If you have any questions about this change, please call the Provider Blue Line SM at 1-800-214-4844.