All PlansReimbursementHigh impact
Mutual News Q1 2022 Newsletter
Medical Mutual of Ohio·General Surgery, Orthopedics, Ophthalmology +8 more·Mutual News Newsletter
Effective date
May 22, 2022
We identified it
Jun 20, 2026
Summary
Medical Mutual has updated surgical procedure modifier reimbursement policies and compliance validation edits. Key changes include specific payment percentages for modifiers 52-78 on surgical procedures and new claim validation requirements for provider identification and rendering locations.
Action Required
By May 22, 2022: Billing team must update claim submission processes to ensure NPI numbers are active in NPPES registry as of service dates. Verify rendering/service location names are only reported when different from billing provider. Review surgical claims using modifiers 52, 53, 54, 55, 56, and 78 - expect payment reductions per CMS guidelines (50% for modifier 52, clinical review for 53, CMS percentages for 54-56 and 78). Update staff training on compliance validation edits to prevent claim returns.