Does modifier 54 reduce payment?

Currently, Blue Cross policy for modifier -54, as found in the Blue Cross Provider Policy and Procedure Manual, indicates that payment will be made at 90% of the surgery allowed amount. For claims received and processed on or after July 1, 2015, the payment amount will be changed to 80% of the surgery allowed amount.

Does modifier affect payment?

In some cases, addition of a modifier may directly affect payment. Placement of a modifier after a CPT or HCPCS code does not insure reimbursement. Medical documentation may be requested to support the use of the assigned modifier.

What is a 54 modifier used for?

Modifier 54 When a 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 this modifier to the usual procedure code.

Does modifier 52 affect payment?

Modifiers -52 and -53 are no longer accepted as modifiers for certain diagnostic and surgical procedures under the hospital outpatient prospective payment system.

Can modifier 54 and 55 be billed together?

Using Modifiers “-54” and “-55” While doing billing the physician must use the same CPT code for global surgery services billed with modifiers 54 or 55. For surgical care only and post-operative care only, the same date of service and surgical code must be reported.

What specialty is most likely to use modifier 54?

HMSA pays for most surgical procedures including preoperative visits, the surgery, and postoperative visits as a “surgical package” or “global fee.”

What modifiers are payment modifiers?

Payment modifiers include: 22, 26, 50, 51, 52, 53, 54, 55, 58, 78, 79, AA, AD, TC, QK, QW, and QY. Informational or statistical modifiers (e.g., any modifier not classified as a payment modifier) should be listed after the payment modifier.

How Does Medicare pay for modifier 52?

The reimbursement for the 52 modifier will be based on what was completed and accomplished. To determine the amount to charge, reduce the normal fee by the percentage of the service not provided. For example, if 75% of the normal service was provided, reduce the amount billed to Medicare by 25%.

What is a surgical package?

The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure.