Wiki Modifier 55

[nlbarnes]

Is modifier 55 used only when a provider outside of the group used? Example: Dr. P from head/neck performs tonsillectomy on 04/04/22. Pt has post op bleeding at the site. Dr. B from same dept/group performs 42870. Wouldn't the E/M not be billable, only the procedure without modifier 55.

 

[thomas7331]

Physicians of the same specialty within the same practice are treated by payers as being the same provider. So the global surgery package that applies to the procedure performed by one provider will also apply to other providers of that specialty in the practice. Modifiers 54 & 55 are only used when one provider is performing the surgery but then transferring care of the patient in the post-operative period to a provider either outside the practice, or sometimes to a provider of a different specialty within the practice.

 

[nlbarnes]

Physicians of the same specialty within the same practice are treated by payers as being the same provider. So the global surgery package that applies to the procedure performed by one provider will also apply to other providers of that specialty in the practice. Modifiers 54 & 55 are only used when one provider is performing the surgery but then transferring care of the patient in the post-operative period to a provider either outside the practice, or sometimes to a provider of a different specialty within the practice.

Thank you...