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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
Appropriate Usage of Modifier 54
When the surgeon transfers all or part of the post-op care to a provider outside their group
Append to the surgery procedure code with a 010 or 090-day post-op period
Applies when the surgeon fully transfers critical care services to another provider
Inappropriate Usage of Modifier 54
Appending modifier 54 to a surgical procedure
Without a global period or
With a global period other than 010 or 090
When the covering provider belongs to the same group
This can include fee-for-time compensation arrangements
Appending to an Evaluation and Management (E/M) procedure code
Appending to an assistant at surgery service
All medical procedures that include a “global period” are comprised of three parts: pre-operative services, intra-operative services (e.g., performance of the actual surgery/procedure), and post-operative care (related follow-up visits during the 10- or 90-day global period). If a physician does not perform all three parts of the service, compliant coding dictates that you append modifier 54 Surgical care only, modifier 55 Post-operative management only, and modifier 56, as appropriate.