Payment Policy

Policy Num:       PP.002.009
Policy Name:     Reduced Services
Policy ID:           [PP.002.009]  

Last Review:      May 12, 2026
Next Review:      May 15, 2027

Publication Date: June, 2026
 

Related Policies:None

Reduced Services

Summary

As defined in the Current Procedural Terminology (CPT®) book, a reduced service is where a service or procedure is partially reduced or eliminated at the discretion of the physician or other healthcare professional.

Policy Statements

It is at the physician’s discretion to partially reduce or eliminate a service or procedure. Under these circumstances, the service provided can be identified by its usual procedure number and the addition of Modifier 52, signifying that the service is reduced. Reimbursement of Modifier 52 is 70% of the usual allowable amount. Multiple procedure reductions may also apply.
It is not appropriate to use Modifier 52 if a portion of the intended procedure was completed and a code exists which represents the completed portion of the intended procedure. If Modifier 52 was not reported when indicated by post payment clinical records review, Triple S will apply appropriate edit and adjust payment consistent with this policy.
For procedures that were started but discontinued before completion due to extenuating circumstances or those that threaten the well-being of the patient, see the Discontinued Procedure Policy (PP.002.008)
describing the use of Modifier 53.

Policy Guidelines

Modifier 52:

Uses and Scenarios:

• Reduced radiology or other procedures: When a procedure is not fully completed, but some elements are performed. 
• Elective reductions: The provider chooses to perform less than the full service. 
• Unilateral procedures: When a procedure that is usually bilateral is only performed on one side, like a unilateral tonsillectomy. 
• Partial completion of a procedure: If a procedure is started but not completed for reasons other than unforeseen circumstances (use modifier 53 for that), modifier 52 can be used. 

Inappropriate Uses:

• Termination of a procedure: Modifier 52 should not be used to report the termination of a procedure. 
• On time-based codes: It is not appropriate to use on codes that are based on the duration of the service. 
• On evaluation and management (E/M) services: Modifier 52 should not be used with E/M services. 
• When anesthesia is involved: If anesthesia is administered, modifier 52 is not applicable; use modifier 53 if the procedure is discontinued, as per CMS guidelines. 

• Difference from Modifier -53:

  Modifier -53 indicates a discontinued procedure, meaning the procedure was stopped after it was started. Modifier -52, on the other hand, indicates a reduced procedure, meaning it was performed but not to the full extent. 

Coding/Billing

52 Reduced Services. The Current Procedural Terminology (CPT^®) code 52 as maintained by American Medical Association, is a medical procedural code under the range - Provider Services and Ambulatory Service Center Modifiers.

Medicare National Coverage

CMS Pub. 100.4, Chapter 4, Section 20.6. Date: March 31, 2023

References

1. American Medical Association, Current Procedural Terminology (CPT®). Professional Edition
2. Centers for Medicare and Medicaid Services, CMS Manual System and other CMS publications
and services

3. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r442cp.pdf

4. https://medicare.fcso.com/coding/modifier-52-fact-sheet

Policy History