• Postoperative care is generally included in the reimbursement for the surgery and is not separately payable
• When the global surgical fee is submitted, CPT modifiers 54 and 55 do not apply
• Postoperative care (E/M services) may be reimbursed separately if the care is not related to the surgery. Refer to instructions for CPT modifier 24 in the Palmetto GBA Modifier Lookup by selecting the 'Browse by Topic' on the left side of this Web page.

Physicians in group practice

• When different physicians in a group practice participate in the care of the patient, the group must submit the claim for the entire global package if the physicians reassign benefits to the group
• The physician who performs the surgery must submit the service as the performing physician. The group that employs the physician must be reflected on the claim as the billing provider.
• When the global surgical fee is submitted, CPT modifiers 54 and 55 do not apply

Physicians Who Furnish Part of a Global Surgery Package: Split Post-Op Care 
When physicians provide only part of the care in the global surgery package, each physician involved in the surgical and postoperative care must identify the specific services he/she provides. Payment for the postoperative, post-discharge care is split between two or more physicians where the physicians agree on the transfer of postoperative care.

• Surgeons who perform the major surgery and provide partial follow up care during the global period of a surgery submit the surgery with CPT modifier 54 (Surgical care only) on one detail line
• The second detail line must indicate the surgery date as the date of service, the same surgery code with CPT modifier 55 (Postoperative management only) 
• The number of post-operative days must appear in the documentation record for electronic claims and the days/units (quantity) field must reflect '1.' For paper claims, the number of days must appear in Item 24g of the CMS-1500 claim form.
• When two or more physicians provide split postoperative care, the assumed/ relinquished postoperative date of care must be indicated in the appropriate documentation record for electronic claims or in Item 19 of the CMS-1500 claim form for paper claims
• Each provider will be reimbursed based on the proportionate percentage of care. When more than one physician furnished 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 in policies, e.g., the surgeon performs only the surgery and a physician other than the surgeon provides preoperative and postoperative inpatient care, result in payment that is higher than the global allowed amount).

Example of Split Post-Operative Care
Patient A has a cataract removed from her left eye on January, 7, 2009, by Dr. X. The surgery took place in an Ambulatory Surgical Center (ASC). Dr. X follows her post-operatively for the first 10 days, then transfers the remainder of her post-operative care to Dr. Y.

Electronic Claims:
Surgeon: Dr. X

 Physician to whom care was transferred to Dr. Y 

Paper Claims:
Surgeon: Dr. X  

Surgeon: Dr. X 

Transfer of Postoperative Care
When transfer of care occurs immediately after surgery, the physician other than the surgeon who provides the in-hospital postoperative care submits the claim using subsequent hospital care codes for the inpatient hospital care and the surgical code with CPT modifier 55 for the post-discharge care. 

Other Tips  

• In all instances where postoperative care is split between the surgeon and another physician, the surgeon submits the surgery code with the CPT modifier 54
• Physicians who provide follow up services for minor procedures performed in emergency departments must submit the appropriate level evaluation and management office visit code. No modifier is necessary in these situations.
• The physician who performs the emergency room service must submit the claim for the surgical procedure 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 evaluation and management code. No modifiers are necessary on the claim.
• Where a transfer of care does not occur, the services of another physician may either be paid separately or denied for medical necessity reasons, depending on the circumstances of the case

References:

• Refer to the Medicare Physician Fee Schedule Database (MPFSDB). Services reflecting a percentage in the pre-operative, intra-operative, and post-operative fields of the database are valid for CPT modifiers 54 and 55: www.cms.hhs.gov/PfsLookup/
• Additional guidance regarding CPT modifiers 54 and 55 is available in the Palmetto GBA Modifier Lookup tool. Access the Modifier Lookup tool using selecting the 'Browse by Topic' on the left side of this Web page.
• Refer to the following for additional information regarding Global Surgery: CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 12, section 40 through 40.D (PDF, 902 KB)