Using Modifier 52 on a CPT Code

November 1, 2014
Rick Gawenda

When a provider is billing the Medicare program for a reduced service, they are to append modifier-52 to that CPT code on the claim form. When billing for a reduced service, providers should reduce the billed amount by 50% just as providers are to increase a bilateral billing by 50%. Maintaining the same charge for a reduced service is not proper billing. Please make sure that when you submit any CPT code with modifier-52, that you are also reducing the billed amount by 50% prior to submission of the claim to your Medicare contractor.

Two examples of when a provider would append modifier-52 both apply to speech-language pathology services and involve CPT codes 92523 and 92520. The first example is when a speech-language pathologist (SLP) performs an evaluation of language comprehension and expression (CPT code 92523) without also performing an evaluation of speech sound production. The description of CPT code 92523 reads “Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression. In this instance, the SLP would still bill

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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