Wednesday, March 3, 2010

Medical billing Modifiers 54 & 55

Medicare Part B modifiers - 54
Surgical Care Only: When one physician performs a surgical procedure and another
provides preoperative and/or postoperative management, surgical services may be identified
by adding the modifier 54 to the usual procedure code.

Services billed with a 54 modifier will be reimbursed at the intraoperative
allowance for the surgical procedure. The intraoperative allowance includes the
one day preoperative care, the intraoperative service, as well as any in-hospital
visits that are performed.

Medicare Part B modifiers - 55 Postoperative Management Only:

When one physician performs the postoperative management and another physician has performed the surgical procedure, the postoperative component may be identified by adding the modifier 55 to the usual procedure number. This modifier is used to identify postoperative, out of hospital medical care associated with a given surgical procedure. When billing for postoperative care only, report the original date of surgery as your date of service and the procedure code for the surgical procedure followed by the 55 modifier.

In rare situations where the out of hospital postoperative care is split between physicians, each physician must also indicate the period of his/her responsibility for the patient’s postoperative care by reporting the appropriate range of dates. Where a transfer of postoperative care occurs, the receiving physician cannot bill for any part of the global services until he/she has provided at least one service.

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