US · guidance
CMS Pub. 100-04, ch. 12, § 20.4.6
Payment Due to Unusual Circumstances (Modifiers “-22” and “-52”)
B3-15028
The fees for services represent the average work effort and practice expenses required to
provide a service. For any given procedure code, there could typically be a range of work
effort or practice expense required to provide the service. Thus, A/B MACs (B) may increase
or decrease the payment for a service only under very unusual circumstances based upon
review of medical records and other documentation.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
10565e3d45623237ec057032219d61b2bd3fc48406ba3aace2a053bb310290ab
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