This policy describes reimbursement for components of the global surgical package. The policy applies to professional services reported on a CMS1500 claim form (or its electronic equivalent).
The surgical package consists of preoperative, intraoperative (surgical), and postoperative components. The surgical package is usually performed by a single physician. A split surgical package occurs when the postoperative care is rendered by a physician other than the physician performing the surgical service.
Split surgical package services are reported using the surgical procedure code appended by the appropriate modifier based on the services performed:
Modifier 54: Surgical Care Only – When one 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 modifier 54 to the usual procedure number.
Modifier 55: Postoperative Management Only – When one physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number.
Modifier 56: Preoperative Management Only – When one physician or other qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure, the preoperative component may be identified by adding modifier 56 to the usual procedure number.
