Modifier 54, Modifier 55

Global Surgical Split Care Payment In A Method II CAH (Modifier 54 – 55)

Global surgical procedures rendered by a physician that has reassigned their billing rights to a CAH Method II provider is payable by Medicare only when billed on an 85x type of bill (TOB) with revenue code (RC) 096x, 97x, and/or 98x and modifier 54 (surgical care only) and/or 55 (postoperative management only).

There are occasions when more than one physician provides services included in the global surgical period, i.e., when the physician who performs the surgical procedure does not furnish the follow-up care. If this occurs, payment for the postoperative or post-discharge care should be split between the physicians when they agree on the transfer of care.

When more than one physician furnishes services that are included in the global surgical package, the sum of the amount approved for all physicians may not exceed what would have been paid if a single physician provides all services (except where stated policies, e.g., the surgeon performs only the surgery and a physician other than the surgeon provides preoperative and postoperative care, result in payment that is higher than the global allowed amount).

CAH Method II providers may review the Global Surgical pricing rules in Pub. 100-04, Chapter 12, sections 40.1-40.5


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