A professional provider or professional providers in the same provider group may perform more than one surgical procedure on the same individual, during the same operative session, or on the same date of service. Therefore, the Company has established claims processing methodologies and guidelines for the reimbursement of multiple surgical procedures.
The Company defines surgery as the performance of generally accepted operative and cutting procedures including but not limited to specialized instrumentations, endoscopic examinations, and other procedures.
The American Medical Association (AMA) classifies certain Current Procedural Terminology (CPT) codes as add-on codes and Modifier 51 exempt codes.
An add-on code represents a supplemental procedure or service that is performed in addition to a primary procedure. Add-on codes are performed by the same professional provider who performed the primary procedure or service. Add-on codes are not stand-alone codes.
A Modifier 51 Exempt code may be a stand-alone code. However, when performed in conjunction with another surgical procedure it is not considered a multiple procedure.