Policy Num: PP.002.008
Policy Name: Discontinued Procedure
Policy ID: [PP.002.008]

Discontinued Procedure

DESCRIPTION:
The term discontinued procedure designates a surgical or diagnostic procedure provided by a physician or other health care professional that was less than usually required for the procedure as defined in the Current Procedural Terminology (CPT®) book. Discontinued procedures are reported by appending Modifier 53. Modifier 53 is used when a procedure was started but was discontinued before completion due to extenuating circumstances or those that threaten the well-being of the patient.

Policy Statements

Reimbursement of discontinued procedures with Modifier 53 is 50% of the allowable amount for the primary unmodified procedure. Multiple procedure reductions may also apply.If, based on post payment clinical records review, Modifier 53 was not reported when indicated, Triple S will apply the appropriate edit and adjust payment consistent with this policy.

Exception: For procedure codes 44388, 45378, G0105, & G0121, Centers for Medicare and Medicaid Services (CMS) publishes relative values (RVUs) for Modifier 53. Therefore, the allowance for these procedures will be based on the RVU rate via the fee schedule and an additional 50% reduction is not applied. Modifier 53 is not used to report the elective cancellation of a procedure, prior to the patient’sanesthesia induction and/or surgical preparation in the operating suite.

Policy Guidelines

Modifier 53 indicates a surgical or diagnostic procedure was started but discontinued due to extenuating circumstances. It is used when a physician or other qualified healthcare professional elects to terminate a procedure after it has begun, often due to factors that could endanger the patient's well-being. Modifier 53 should not be used for elective cancellations or for procedures discontinued before the patient is under anesthesia.

For procedures that are partially reduced or eliminated at the physician’s direction, see the Reduced Services Policy (PP.002.009) describing the use of Modifier 52.
BILLING AND CODING:
According to the CMS and CPT® coding guidelines, Modifier 53 should be used with surgical codes or medical diagnostic codes.

- Discontinued Procedure: A surgical or diagnostic procedure started but terminated due to unforeseen circumstances.
- After Anesthesia: The procedure is discontinued after the patient has been given anesthesia (local, regional, or general).
- After Procedure Initiation: The procedure is discontinued after it has begun (e.g., incision made, intubation started).
When NOT to Use Modifier 53:
- Elective Cancellation: For cancellations of procedures before the induction of anesthesia or surgical preparation.
  
  Time-Based Codes: Modifier 53 is not used with time-based procedure codes, such as anesthesia, critical care, or psychotherapy.
  
  E/M Services: It is not valid to use with evaluation and management (E/M) services.
  
  Conversions: Not applicable when a laparoscopic or endoscopic procedure is converted to an open procedure.
  
  Additional Considerations:
- Supporting Documentation: When using modifier 53, documentation is required to support the claim, including the reason for the discontinuation and the percentage of the procedure completed.
  
  Reimbursement: A 50% reduction in payment may be applied when modifier 53 is used, unless there is a published RVU for the specific code with modifier 53.
  
  Outpatient Hospital/ASC: For reporting a discontinued procedure in an outpatient hospital or ambulatory surgical center (ASC), modifiers 73 and 74 are used.
  
  Facilities: Modifier 53 cannot be reported by facilities.

Coding/Modifiers:

References

1. American Medical Association, Current Procedural Terminology (CPT®).
2. Centers for Medicare and Medicaid Services, CMS Manual System and other CMS publications and services
3. Centers of Medicare and Medicaid Services (CMS): Medicare Claims Processing Manual, Publication 100-4, Chapter 18 - Preventive and Screening Services, Section 60.2.A2 Colonoscopy Cannot be Completed Because of Extenuating Circumstances and Chapter 23 - Fee Schedule Administration and Coding Requirements https://www.cms.gov/regulations-andguidance/ guidance/manuals/downloads/clm104c18pdf.pdf

5. https://www.aapc.com/codes/coding-newsletters/my-urology-coding-alert/coding-101-know-the-ground-rules-for-reporting-modifier-53-163456-article?srsltid=AfmBOoqOiq2NqcgEN3cGb7t7YsurMozqSTYpynmoQyILuObdS7VQea7t

Date	Action	Description
05/12/2026	Annual review	No changes in Policy statement. Reference added.
05/01/2025	New Payment Policy created	Modifier 53 payment policy.

Discontinued Procedure

Summary

Policy Statements

Policy Guidelines

Coding/Modifiers:

References

Policy History