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
Popular Posts
-
Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...
-
An OPPS payment status indicator is assigned to every HCPCS code. The status indicator identifies whether the service described by the H...
-
Claim Adjustment Reason Codes (CARC) CO-22 or PR-22 This care may be covered by another payer per coordination of benefits. CO-19 This is...
-
This procedure is medically necessary only when it requires the professional skills of a therapist, is designed to address specific ne...
-
Mohs surgery, also known as chemosurgery, created by a general surgeon, Dr. Frederic E. Mohs, is performed to remove complex or ill-defi...
-
Definition: The “-59” modifier is used to indicate a distinct procedural service. The physician may need to indicate that a procedure or...
-
Ambulance transportation is a covered service when the patient’s condition is such that the use of any other method of transportation would...
-
AAPC’s Certified Professional Coder (CPC) credential is the gold standard for medical coding in physician office settings and held by more ...
-
This procedure may be medically necessary for training patients whose walking abilities have been impaired by neurological, muscular, o...
-
Sentinel lymph node identification and biopsy typically involves a multidisciplinary approach. A nuclear medicine procedure called lymph...