Global Surgical Split Billing

If different physicians perform portions of the global service, modifiers should be used with the surgical procedure code having a 90 day postoperative period to indicate what portion of the service each provided. Each physician will be reimbursed a percentage of the global fee. The percentages allocated for pre-operative,intra-operative and post-operative services will vary foreach surgical procedure. The sum of the amount approved for all physicians may not exceed what would have been paid if a single physician provided all services.

-54 Surgical Care Only: When one physician performs a surgical procedure and another
provides postoperative management, surgical services may be identified by adding
modifier -54 to the usual procedure number.

-55 Postoperative Management Only: When one physician performed the postoperative
management and another physician performed the surgical procedure, the postoperative
component may be identified by adding modifier -55 to the usual procedure number.

-56 Preoperative Management Only: When one physician performed the preoperative care and evaluation and another physician performed the surgical procedure, the preoperativecomponent may be identified by adding the modifier -56 to the usual procedure number.

This modifier is not valid for Medicare claims.