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West Virginia Part B Carrier
Supporting Documentation and Coding Requirements for Postoperative Care: CPT Modifier 55

When submitting CPT Modifier 55, supporting documentation is always required and must be submitted as follows:
Electronic Claims:
  • Submit the assumed/relinquished date of the postoperative care and the number of post-operative days in the electronic documentation field
  • Quantity billed (days/units field) must be submitted as '1'
  • Date of Service must be the surgery date
  • The procedure code must match the procedure code billed with CPT Modifier 54
Paper Claims:
  • Indicate the assumed/relinquished date of the postoperative care in Item 19 of the CMS-1500 claim form
  • Indicate the number of post-operative days in Item 24G (days/units field) and do not submit a quantity billed (days/units) of '1' unless only one postoperative day of care was provided
  • Date of Service must be the surgery date
  • The procedure code must match the procedure code billed with CPT Modifier 54
Documentation submitted via fax or as a separate attachment to the CMS-1500 claim form will not be accepted for CPT Modifier 55 services and will result in the service being rejected.

Note: A fax submitted for other service(s) on the claim will be considered if acceptable per the service’s documentation requirements.

 

last updated on 04/02/2009
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