56 modifier cpt

(2023) Modifier 56 | Preoperative Management Only Explained

Are you looking for information on how to bill modifier 56? Underneath the description, coding guidelines, and reimbursement of this modifier.

Description Of Modifier 56

The official description of the 56 modifier is: “Preoperative Management Only.”

When one physician performed the preoperative care and evaluation, and another performed the surgical procedure, the preoperative component may be identified by adding modifier 56 to the usual procedure number.

Coding Guidelines

  • You may use modifier 56 with surgical codes only to indicate that only the pre-operative care was performed.
  • Do not submit modifier 56 on CPT codes that have 0-day Global period. For example, CPT 45378 (Colonoscopy diagnostic)
  • Do not submit modifier 56 on E & M services.
  • Do not submit modifier 56 and other Global Surgical split billing modifier 54 and modifier 55.
  • Do not submit the 56 modifier along with modifier 80 (Assistant Surgeon), modifier 81 (Minimum Assistant Surgeon), modifier 82 (Assistant Surgeon when qualified resident surgeon not available), and modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant-at-surgery, non-team member).


Medicare does not recognize the use of Modifier 56. However, Medicare physician Fee schedule database contains a field that shows a percentage of 10 % of the actual allowed amount if a physician performed only the Pre-operative portion of a surgery.

All major commercial insurance will follow these CMS designations. The reimbursement will be 10 % for the Pre-operative portion of the surgery with a Global Days field equal to 010 or 090 on the Medicare Physician Fee Schedule Relative Value file.

Go back to the list with all CPT modifiers.

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