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Modifier 51 on diagnostic test codes

  1. Default Modifier 51 on diagnostic test codes
    Medical Coding Books
    Does modifier 51 apply to diagnostic procedure codes or just surgical codes? If it applies to diagnostic codes, under what circumstances should it be used? What about ophthalmology diagnostics - if one procedure is performed by a tech and another by the physician, should we use modifier 51?

  2. Default
    51 modifier is most appropriately used for surg codes in order for the payor to utilize the multiple surg pricing rules. For diagnostic testing you need to use a 59 or a 76 depending on the payor. For example, BCBS likes 76 for diagnostic procedures whether it is a repeat diagnostic test or not.

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