CPT Modifier 54
Surgical care only.
Guidelines and Instructions
Submit CPT® modifier 54 when one physician performs a surgical procedure and another provides preoperative and/or postoperative management.
- Submit this modifier with the surgical procedure code for only the pre-operative and intra-operative care (excludes the post-operative care)
- Surgeons performing the major surgery and providing partial follow up (post-operative) care during the global period of a surgery must submit the claim as follows:
- Submit the surgery with CPT® modifier 54 (surgical care only) on one detail line
- On a separate detail line submit the surgery date as the date of service, the surgery code with CPT® modifier 55 (postoperative management only) and the number of postoperative days the patient was under the surgeon's care (e.g., 30). Refer to CPT modifier 55 for additional instructions regarding postoperative management.
- To prevent duplicate denials and confusion, a laterality modifier (HCPCS modifier RT or LT), when applicable, should also be submitted and is required for some procedure codes
- To view the fee schedule pre-operative and intra-operative percentage that applies to the surgery, refer to those columns of Medicare Physician Fee Schedule database (MPFSDB)
- Access the database directly from the CMS website
- Example: If the Pre-op column reflects 10 percent and Intra-op column reflects 80 percent, the “allowed” amount for services submitted with CPT modifier 54 will be reduced to 90 percent of the fee schedule amount.
- CMS Pub. 100-04, Chapter 23, at the end of the chapter (PDF)
- CMS Pub. 100-04, Chapter 12, Sections 40.2-40.5 (PDF)
- CMS Pub. 100-04, Chapter 26, Section 10.4, Item 19 (PDF)