New Reimbursement Policy for Services Appended with Modifier 52

In order to align with Centers for Medicare & Medicaid Services standards, we have implemented a new reimbursement policy for services appended with Modifier 52 (Reduced Services). Effective January 1, 2015, Horizon NJ Health will reimburse services billed in conjunction with Modifier 52 at 50 percent of the applicable fee schedule amount.

Please be aware that Modifier 52 does not provide for reimbursement of an ineligible service and no additional reimbursement will be issued if the reimbursement is via capitation or captured in a global rate.

Note that the following CPT/HCPCS codes are excluded from this new Modifier 52 policy: