Palmetto GBA has discovered some providers have been filing incorrect information in Item 24G on the CMS-1500 Claim Form, yet the claims were being paid. When filing paper claims, you must enter CPT modifier 55 under the number of post-operative days in Item 24G and the assumed or relinquished dates of the post-operative care in Item 19 of the CMS-1500 Claim Form. This will 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).
Effective September 1, 2009, we will deny any paper claims not filed with the correct information in Item 24G.
For the complete guidelines for CPT modifier 55, please refer to the 'Modifier Lookup' tool on the Self Service Tools and Top Links page of our Web site.