Modifier 54 indicates that a physician or qualified health care professional (QHP) performed a surgical procedure and transferred the postoperative management to another provider. The 55 modifier indicates that a physician or QHP other than the surgeon performed the postoperative care only.

What is the difference between modifier 54 and 55?

Modifier 54 indicates that a physician or qualified health care professional (QHP) performed a surgical procedure and transferred the postoperative management to another provider. The 55 modifier indicates that a physician or QHP other than the surgeon performed the postoperative care only.

What is modifier 54 used for?

Modifier 54 When a physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding this modifier to the usual procedure code.

Can modifier 54 and 55 be billed together?

Using Modifiers “-54” and “-55” While doing billing the physician must use the same CPT code for global surgery services billed with modifiers 54 or 55. For surgical care only and post-operative care only, the same date of service and surgical code must be reported.

What specialty is most likely to use modifier 54?

surgical care
The provider who performed surgical care should append modifier 54 to the appropriate CPT® code(s) to describe the surgery performed. The modifier signals that the surgeon intends to relinquish “all or part of the post-operative care” to another provider, per CMS.

How do you bill a cataract co manager?

CPT code for cataract surgery is “66984” Modifiers are “55” for co-management, “RT” for right eye or “LT” for left eye, and “79” if it is the 2nd eye within post op period (90 days) of the first eye.

What is the correct order of following modifiers 54 55 56?

What is the correct order of the following three modifiers:-54, -55, -56? Surgery care only, Post-Op, Pre-op.

What does CPT code modifier 55 mean?

Modifier 55 is billed by the receiving physician, other than the surgeon, who accepts the transfer of care and furnishes postoperative management services.

What type of modifier is 54?

The use of modifier 54 indicates the surgeon has transferred postoperative care (partial or total) to another provider, and the surgical code with modifier 55 appended will be billed by the receiving provider to whom the postoperative care was transferred.

How do you bill Post op after cataract surgery?

Use the same surgical CPT procedure code used by the surgeon, but add the -55 modifier to signify that you are rendering the postoperative care. The number of units billed can vary by carrier, so be aware of your carriers requirements.

Can you bill for a refraction after cataract surgery?

Yes. Under Medicare law (Social Security Act, 1861(s)(8)), beneficiaries are covered for post-cataract eyeglasses following cataract surgery with implantation of an IOL. However, Medicare does not pay for the refraction to prescribe those eyeglasses.

How do you bill for post op care only?

In those cases where the postoperative care is “split” between physicians, the billing for the postoperative care should be reported as follows: Report the date of service using the date of the surgical procedure. Report the procedure code for the surgical procedure, followed by modifier 55.

How does modifier 54 affect reimbursement?

Why is refraction not covered by Medicare?

The charges for a refraction are covered by some insurances but not all. For example, Medicare does not cover refractions because they consider it part of a “routine” exam and Medicare doesn’t cover most “routine” procedures – only health-related procedures.

What is the 55 modifier?

postoperative management services
Modifier 55 is billed by the receiving physician, other than the surgeon, who accepts the transfer of care and furnishes postoperative management services.

How do you bill for multiple surgery?

Use the current version of the NCCI edits. If the secondary procedures are not component codes of the primary procedure, and the procedure was the same (as defined above), bill the primary procedure with no modifier, and the secondary procedures with -51 modifier.

What is considered post op care?

Postoperative care is the care you receive after a surgical procedure. The type of postoperative care you need depends on the type of surgery you have, as well as your health history. It often includes pain management and wound care. Postoperative care begins immediately after surgery.

Does Medicare ever pay for refraction?

Medicare doesn’t cover eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses. You pay 100% for eye exams for eyeglasses or contact lenses.

Does routine eye exam include refraction?

A refraction test is usually given as part of a routine eye examination. It may also be called a vision test. This test tells your eye doctor exactly what prescription you need in your glasses or contact lenses. Normally, a value of 20/20 is considered to be optimum, or perfect vision.