Skip to content
Sales: 888-357-3226

Medical Billers and Coders Logo
  • Our Specialties
      • We Excel In
      • Ambulance Transportation
      • ASC
      • Wound Care
      • DME
      • Oncology
      • Optometry
      • More Specialties »
      • We Dominate Over
      • Florida
      • Illinois
      • Ohio
      • Georgia
      • New York
      • Texas
      • New Jersey
      • We also Serve in »
      • Our Reach
      • Atlanta
      • Chicago
      • Dallas
      • Houston
      • Jacksonville
      • New York
      • Philadelphia
      • We also Serve in »
  • Services
      • Medical Billing
      • Charge Entry
      • Payment Posting
      • Account Receivable
      • Denial Management & Appeals
      • RCM Services
      • Medical Coding
      • Physician Credentialing
      • Physician Group
      • Outsourced Services
  • Resource Center
      • Best Billing Practices
      • Specialty Billing Guideline
      • Press Release
      • Newsletter
      • Billing Insight
      • Billing and Coding Updates
      • Billers and Coders Digest
      • Something of Interest
      • Infographics
      • Quiz
      • Glossary
      • Case Study
      • In house Blogs
      • Medical Billing Blog
      • DME Billing Blog
      • Pharmacy Billing Blog
  • Articles / Blogs
    • Articles
    • MBC Blog
    • DME Blog
    • Pharmacy Blog
  • Company
    • About Us
    • Contact Us
    • Careers
Read our latest medical billing and coding blogs
  • Contact
  • Sample Page
  • Subscribe
  • UnSubscribe

Leading Medical Billing Company in the US.

Helping Physician Groups to Stay Profitable

With Transparent RCM Services

Contact us today!

Don’t let your accounts receivables

Stress you?


Contact our Account Receivables Specialist today!

Contact Now

$ can come consistently

MBC is the solution

Request a Quote

  1. Home
  2. Revenue Cycle Management (RCM)
  3. Use of Modifiers 54, 55, and 56

Use of Modifiers 54, 55, and 56

Using Modifiers, the service or procedure can be altered by some specific conditions but has not been changed in definition or code. The intention of modifiers is to give more specific information about a specific procedure or service that is not already contained in the code definition itself. MBC is sharing more information on Use of Modifiers 54, 55, and 56 here below.

GLOBAL SURGERY BILLING and CODING Modifiers 54, 55, and 56

Physicians who carry out the surgery and give all of the usual pre- and post-operative care may bill for the global package by entering the appropriate CPT code for the surgical procedure only. Separate billing is not allowed for visits or other services that are included in the global package.

When different physicians in a group practice participate in the care of the patient, the group practice bills for the entire global package if the physicians reassign benefits to the group. The physician who performs the surgery is reported as the performing physician.

Modifier Definitions:

Modifiers 54 : Surgical Care Only

When one physician or other skilled health care qualified performs a surgical procedure and another provider preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number.

Modifier 55 : Postoperative Management Only

When one physician or other skilled health care qualified performed postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number.

Modifier 56: Preoperative Management Only

When one physician or other skilled health care qualified 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

Using Modifiers “-54” and “-55”

Where physicians agree on the transfer of care during the global period, services will be distinguished by the use of the appropriate modifier.

While doing billing the physician must use the same CPT code for global surgery services billed with modifiers 54 or 55. For surgical care only and post-operative care only, the same date of service and surgical code must be reported. The date of service is the date the surgical procedure was carried out.

Modifier 54 specifies that the surgeon is relinquishing all or part of the post-operative care to a physician.

  • Modifier 54: does not apply to assistant-at-surgery services.
  • Modifier 55: does not apply to an Ambulatory Surgical Center (ASC’s) facility fees.

The physician, other than the surgeon, who furnishes post-operative management services, bills with modifier “-55.”

  • Use modifier 55 with the CPT procedure code for global periods of 10 or 90-days.
  • Report the date of surgery as the date of service and indicate the date that care was relinquished or assumed. Physicians must keep copies of the written transfer agreement in the beneficiary’s medical record.
  • The receiving physician must provide at least one service before billing for any part of the postoperative care.
  • This modifier is not appropriate for assistant-at-surgery services or for ASC facility fees.

Exceptions

Where a transfer of care does not occur, occasional post-discharge services of a physician other than the surgeon are reported by the appropriate E/M code. No modifiers are necessary on the claim.

Physicians who provide follow-up services for minor procedures performed in emergency departments bill the appropriate level of E/M code, without a modifier.

If the services of a physician, other than the surgeon, are required during a postoperative period for an underlying condition or medical complication, the other physician reports the appropriate E/M code. No modifiers are necessary on the claim. An example is a cardiologist who manages the underlying cardiovascular conditions of a patient.

For more information, refer to the Medicare Claims Processing Manual

Preoperative Care (modifier code -56)

During the preoperative visit, the surgeon discusses the surgery to be performed, evaluates the patient’s condition and ability to tolerate the planned surgery, prepares the admission documents, and has the patient sign the appropriate consent forms. These services are not customarily delegated to another physician.

In some cases, the patient may have an ongoing physical issue that could carry additional risk during surgery. In such a case, the surgeon might ask the patient to visit a specialist or their internist for surgical clearance. When this occurs, the specialist or internist will bill for the appropriate consultation or office visit and use the patient’s condition as the primary diagnosis.

Inacceptable procedure code/split care modifier combinations:

  • Modifiers 54, 55, and 56 (aka split global-care billing) do not apply to procedure codes with a 0-day postoperative period.
  • Modifiers 54, 55, and 56 are not considered valid for obstetric care procedure codes, as specific codes already exist to identify when more than one provider provides antepartum, delivery, and postpartum care.
  • Modifiers 54, 55, and 56 are not considered valid for provider types to which the global surgery concept and a postoperative care global period do not apply:
    • Assistant surgeons
    • Ambulatory Surgery Centers
    • Outpatient Hospitals
    • Inpatient Hospitals
  • Modifiers 54, 55, and 56 are not considered valid for E/M, anesthesia, radiology, laboratory, medicine, or ambulance procedure codes, or any non-surgical HCPCS code.

About Medical Billers and Coders

We are catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders.

Posted by Medical Billers and Coders October 13, 2020June 15, 2021General Surgery Billing Services, Revenue Cycle Management (RCM)

Post navigation

Previous: COVID-19 – CPT Codes for Multi-Virus Tests
Next: Uninsured COVID-19 Patients with Limited Reimbursement

Search Our Blog Posts

Get a Quote

Are you looking for more than one billing quotes?

Categories

  • Categories
    • Accounts Receivables
    • Ambulance Billing Services
    • Ambulance Transportation Billing Services
    • Ambulatory Surgical Centers
    • Behavioral Health Billing
    • Cardiology Billing Services
    • Chiropractic Billing Services
    • Claims Denials
    • Credentialing Services
    • Dental Billing Services
    • Dermatology Billing Services
    • DME Billing Services
    • EMR / EHR / Health IT
    • EMS Billing Services
    • ENT Billing Services
    • Family Practice Billing Services
    • Gastroenterology Billing Services
    • General Surgery Billing Services
    • Geriatrics Billing Services
    • Health Insurance
    • Healthcare Reforms
    • HIPAA / ACA / ACO
    • Hospitalist Billing
    • Infographics
    • Insurance / Payer
    • Internal Medicine Billing Services
    • Medical Billing Services
    • Medical Coding
    • Mental Health Billing Services
    • Neurology Billing Services
    • OB Gyn Billing Services
    • Occupational Therapy
    • Oncology Billing Services
    • Optometry Billing Services
    • Orthopedics billing services
    • Otolaryngology Billing Services
    • Pain Management Billing Services
    • Pathology Billing Services
    • Payment Models
    • Pharmacy Billing Services
    • Physical Therapy Billing Services
    • Physicians/ Doctors
    • Plastic Surgery Billing Services
    • Podiatry Billing Services
    • Practice Administration
    • Practice Management
    • Primary Health Care
    • Radiology Billing Services
    • Revenue Cycle Management (RCM)
    • Skilled Nursing Facilities Billing Services
    • Specialty
    • Uncategorized
    • Urology Billing Services
    • Wound Care Billing Services
  • Recent Posts

    • Gastroenterology Billing Audits: Ensuring Accuracy and Financial Success
    • Collaborative Approaches to Claims Denials: Aligning Billing and Clinical Teams
    • Benchmarking Wound Care Billing Success
    • Balancing Cardiology Quality Care and Financial Health
    • Human Element of RCM: Building Strong Teams for Financial Success

    Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.

    Connect with us

    info@medicalbillersandcoders.com

    Company

    • About Us
    • We Excel In
    • We Dominate Over
    • Testimonials
    • FAQ
    • Privacy Policy
    • Healthcare Analytics

    Services

    • Physicians
    • RCM Services
    • Transcription
    • Consultancy
    • Medical Coding
    • Hospital Billing
    • Medical Billing Outsourcing

    Resources

    • Best Billing Practices
    • Articles
    • Press Release
    • Case Study
    • Billing Guidelines
    • Medical Billing Quiz
    • Billing Bytes

    HIPAA

    ICD-10

    • ICD-10 Services
    • ICD-9 to ICD-10
    • ICD-10-E-book

    Refer a Friend

    HTML Sitemap

    Copyright © 2023 Medical Billers and Coders All Rights Reserved.

    REQUEST A CALL BACK

    Are you looking for more than one billing quotes?