Modifier 54, Modifier 55, Modifier 56

Global Surgical Split Billing Modifiers (Care Transfer 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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