Modifier 54

Surgical Care Only

Instructions

Modifier 54 explains that the surgeon performed the surgical service. The surgical allowance includes the one day preoperative care, intraoperative service and any hospital visits performed.

Correct Use

  • Surgeon performs surgery
    • Bill with modifier 54
  • Surgeon also performs all/partial post operative care
    • Bill separate line with modifier 55 (see separate fact sheet)
    • Reflect in narrative date span
    • Bill all lines with surgical date of service

Incorrect Use

  • Do not bill the day after for the post operative care; must be the same surgical date
  • Not appropriate for E/M, ASC facility or assistant surgery codes

Claim Coding Example

  • An orthopedic surgeon performs an open tibial shaft fracture (27759) and bills the surgery with modifier 54. The partial postoperative care (modifier 55) is provided by both the surgeon (2/15 – 3/31/13) and then turned over to the patient's attending physician for the remaining 45 days (4/1 – 5/15/13).
Surgical Date Treatment Description CPT/Modifier
  Dr. Modi's Bill  
2/15/13 Open tibial shaft fracture 27759 54
2/15/13 Open tibial shaft fracture 27759 55
  Dr. Fier's Bill  
2/15/13 Open tibial shaft fracture 27759 55

Resource

 

Last Updated Dec 09 , 2023