Reduced Services

Billing and Reimbursement
Policy Number: RP-X-007

Last Updated: Dec. 29, 2022

Effective October 15, 2022, Blue Cross and Blue Shield of Nebraska (BCBSNE) reimbursement for reduced services is allowed at 50% of the unmodified amount. Multiple procedure reductions still apply when applicable. Please refer to CPT for modifier descriptions and use. 


When a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional, the service provided can be identified by its usual procedure code and appending modifier 52. By appending modifier 52, the reduced service is being reported without disturbing the identification of the basic service. Modifier 52 should not be used if a portion of the intended procedure was completed, and a code exists which represents the completed portion of the intended procedure.  


When a surgical or diagnostic procedure requiring anesthesia is reduced in an ASC or hospital outpatient setting, modifier 73 or 74 should be appended to identify that the service was reduced or canceled due to extenuating circumstances prior to or after administration of anesthesia. Modifier 52 should only be used on reduced radiology and other services that do not require anesthesia.