Payment Policy Updates

March 5, 2026

The following policies received their annual review with no changes:

The following policies received their annual review with the changes noted below:

This policy is archived effective March 5, 2026. Please refer to modifier 73 and 74 – Discontinued Procedures Outpatient Hospital/Ambulatory Surgery Center policy.

Changed policy name from modifier 73 – Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to Administration of Anesthesia to modifier 73 and 74 – Discontinued Procedures Outpatient Hospital/Ambulatory Surgery Center (ASC).
Added to the policy section:
- Modifier 74 details from modifier 74 policy which was archived effective February 5, 2026.
- Modifier 52 details for procedures that do not involve anesthesia, including radiology services, for outpatient facility billing only.
Added “electively canceled procedures” to the sections defining when modifiers 73 and 74 should not be billed.

Added clarifying details in the policy section for facility use of modifier 52 and professional use of modifier 53: “Modifier 52 may be appended on an outpatient facility claim to indicate a procedure not requiring anesthesia was canceled or discontinued. See the related modifier 73 and 74 payment policy listed in the cross-reference section.”
For a canceled procedure not requiring anesthesia on a professional claim, the provider should use modifier 53 discontinued procedures. Modifier 52 should not be used to report a discontinued or canceled procedure on a professional claim. Documentation must clearly reflect risk to patient or complication and not elective.
Anesthesia includes local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, and general anesthesia. The medical record must include documentation that the procedure was started, why the procedure was discontinued, and at what point the procedure was discontinued. See the modifier 53 policy listed in the cross-reference section of the policy.
Removed from the exclusion section: “This policy does not apply to any provider reimbursed using an ASC ambulatory payment classification (APC) methodology. Current policy criteria align with this payment methodology.”

Added specification to the policy section: “if the procedure requires anesthesia or after the procedure was started.”
Added clarifying statement to the policy section: “If no portion of the procedure was performed, the procedure should not be billed.”
Added clarifying policy reference for modifier 52: "Reduced services should not be appended to report a discontinued procedure for a professional claim."
Added reference to use modifier 52 for outpatient claims to represent a cancelled procedure that does not require anesthesia.