Payment Due to Unusual Circumstances (Modifiers “-22” and “-52”)

20.4.6 - Payment Due to Unusual Circumstances (Modifiers “-22” and “-52”) (Rev. 1, 10-01-03) 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.