CPT Modifier 54

Description
Surgical care only.

Guidelines/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.

Reference

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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