MAR 01, 2020
Reduction in Payment for Higher Allowable Procedure
Question: When performing cataract surgery and goniotomy at the same session, I append modifier -51 to cataract surgery, as it has a lower allowable. However, our Medicaid plan has a higher allowable on the cataract surgery, so I append the goniotomy with modifier -51. We received our remittance advice and noticed payment was reduced by 50% on the cataract surgery. Are they allowed to switch the placement of the modifier?
Answer: Modifier -51 is no longer necessary to append to a second or subsequent surgery. Please double-check the payer’s allowables. Goniotomy has a national average of $808.