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Modifiers for Global Surgical Split Billing (Transfer Of Care Between Providers)


If different physicians perform portions of the global service, modifiers should be used with the surgical procedure code having a 90 day postoperative period to indicate what portion of the service each provided. Each physician will be reimbursed a percentage of the global fee. The percentages allocated for pre-operative , intra-operative and post-operative services will vary for each surgical procedure (refer to the MPFSDB). The sum of the amount approved for all physicians may not exceed what would have been paid if a single physician provided all services.

Modifier -54 Surgical Care Only: When one physician performs a surgical procedure and another provides postoperative management, surgical services may be identified by adding modifier -54 to the usual procedure number.
(Also see Usage and Reimbursement)

Modifier -55 Postoperative Management Only: When one physician performed the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by adding modifier -55 to the usual procedure number. (Also see Usage and Reimbursement)

Modifier -56 Preoperative Management Only: When one physician performed the preoperative care and evaluation and another physician performed the surgical procedure, the preoperative component may be identified by adding the modifier -56 to the usual procedure number. This modifier is not valid for Medicare claims.
(Also see Usage and Reimbursement)

References:

https://www.cms.gov/apps/physician-fee-schedule/

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/227102.pdf

http://www.uhccommunityplan.com/assets/Modifier-Reference-Policy-%28R0111%29-1-1-11.pdf

http://www.or.regence.com/provider/library/policies/reimbursement-policies/modifiers/modifier-54-55-56-split-care.html

http://www.or.regence.com/provider/library/policies/reimbursement-policies/modifiers/oregonmodifiertable.htm

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