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CPT Modifier 55
Description:
Postoperative management only
Guidelines/Instructions:
Use this modifier to indicate that payment for the postoperative, post-discharge care is split between two or more physicians where the physicians agree on the transfer of postoperative care.
Exception: When both physicians are members of the same group, surgery must be submitted as a 'global package' only and not separated into 'surgical care only' and 'postoperative management only' components.
- Claim submission when postoperative management is split between two or more physicians:
- Submit the surgical procedure code, the date of the surgery as the date of service and the place of service is the location where the surgery was performed
- For electronic claims, submit the assumed or relinquished dates of the postoperative care and the number of post-operative days in the electronic documentation field. Submit '1' in the days/units field.
- For paper claims, indicate the assumed or relinquished dates of the postoperative care in Item 19 of the CMS-1500 claim form and the number of post-operative days in the days/units field
- Each provider will be reimbursed based on the proportionate percentage of care
- 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. CPT modifier 55 is not applicable.
- 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
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