Modifier 53; Discontinued Procedure

Policy No: 102
Originally Created: 10/01/2008
Section: Modifiers
Last Reviewed: 08/01/2024
Last Revised: 06/01/2023
Approved: 06/18/2024
Effective: 08/01/2024
Policy applies to: Group and Individual & Medicare Advantage

This policy applies only to physicians and other qualified health care professionals.

Modifier 53 - Discontinued Procedure
Current Procedural Terminology (CPT®) modifier 53 is used due to certain situations when
the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued.

CPT modifier 53 is valid only when a physician or other qualified health care professional elects to terminate a surgical or diagnostic procedure due to extenuating circumstances or circumstances that threaten the well-being of the patient.

CPT modifier 53 should be appended to only one code per operative session. Procedure codes for other procedures not performed at all should not be additionally reported.

CPT modifier 53 is not valid when used for elective cancellation of a procedure prior to anesthesia induction and/or surgical preparation in the operating suite.

CPT modifier 53 is not valid when a laparoscopic or endoscopic procedure is converted to an open procedure or when a procedure is changed or converted to a more extensive procedure. The open procedure or more extensive procedure should be reported.

CPT Modifier 53 is not valid with evaluation and management (E&M) or anesthesia codes.

CPT modifier 53 indicates procedure discontinued by physician or other qualified health care professional and may not be reported by facilities.

Reimbursement for discontinued procedure with modifier 53 is 25% of the allowable amount. The reduction to 25% of the allowable amount will apply when modifier 53 is billed with other pricing modifiers, for example, a discontinued procedure performed by an assistant surgeon.

The fee reduction does not apply to codes with unique Relative Value Units (RVUs) for the modifier 53 combination, such as 44388-53, 45378-53, G0105-53 and G0121-53.

Procedure code/modifier combinations that are considered not valid for our health plans use will be denied.

For outpatient hospital or Ambulatory Surgery Center (ASC) reporting of a discontinued services, see modifier 73 and 74.

American Medical Association. Appendix A – Modifiers. Current Procedural Terminology (CPT). Chicago: AMA Press

Centers for Medicare & Medicaid Services (CMS), Medicare Claims Processing Manual, Chapter 4, section 20.6.4

Centers for Medicare & Medicaid Services (CMS), Medicare Claims Processing Manual, Chapter 12, Section 30.1, subsection B

Centers for Medicare & Medicaid Services (CMS), National Physician Fee Schedule Relative Value File

Centers for Medicare & Medicaid Services (CMS), Medicare Learning Network (MLN) Matters: MM 9317

Noridian Medicare, Jurisdiction F - Medicare Part B, Topic: Modifier 53

Modifiers 73 and 74; Discontinued Services

Modifiers 80, 81, 82 and AS; Assistant at Surgery