Modifiers: This MAC Clarifies Use of Modifiers 54, 55 When Co-Managing Patients

Why This Topic Matters

Claims for split surgical and postoperative care can be denied or misbilled if transfer of care is not documented and billed correctly. Understanding the MAC’s clarification helps practices coordinate claims across physicians, groups, and payment localities.

Article Sections

1. Know the Rules

   Introduces the general concept of transfer of care during the global period and discusses the broad billing framework used when surgical and postoperative responsibilities are split.

2. Avoid Modifier 56

   Addresses Medicare’s treatment of preoperative management and contrasts it with postoperative-only care in the context of global surgical billing.

3. How payment works

   Summarizes how payment for surgical services is generally divided among the preoperative, surgical, and postoperative portions of a global service.

4. Example 1

   Presents a sample transfer-of-care scenario involving a surgical case followed by postoperative management by another physician.

5. Example 2

   Presents another sample scenario showing postoperative care after a surgery performed for an out-of-town patient.

6. Remember

   Highlights coordination and claim-submission considerations for physicians who share care during the global period.

7. Caution

   Notes a claim-processing issue that can arise if the surgical portion and postoperative portion are not reported consistently.

8. Know These Exceptions

   Outlines broad situations in which postoperative visits may not be billed under the split global surgery approach.

9. Two Carriers Might Be Involved

   Explains the relevance of payment locality and MAC jurisdiction when the surgical and postoperative portions occur in different service areas.