The modifiers listed below are used by physicians to indicate a billed service is not part of a global surgical package and is eligible for separate reimbursement.
Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period:
The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding the modifier 24 to the appropriate level of E/M service.
Modifier 24 Fact Sheet
Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service:
It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or be beyond the usual preoperative and postoperative care associated with the procedure that was performed. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service).
The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service.
Note: This modifier is not used to report an E/M service that resulted in a decision to perform major surgery. See modifier 57. For significant, separately identifiable non-E/M services, see modifier 59.
Modifier 25 Fact Sheet
Modifier 25 Tips
Surgical Care Only:
When one physician performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding the modifier 54 to the usual procedure code.
Services billed with a 54 modifier will be reimbursed at the intraoperative allowance for the surgical procedure. The intraoperative allowance includes the one day preoperative care, the intraoperative service, as well as any in-hospital visits that are performed.
Post-Operative Co-Management, Modifiers 54 and 55
Postoperative Management Only:
When one physician performs the postoperative management and another physician has performed the surgical procedure, the postoperative component may be identified by adding the modifier 55 to the usual procedure number.
Post-Operative Co-Management, Modifiers 54 and 55
Decision for Surgery:
An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service.
Modifier 57 Fact Sheet
Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period:
It may be necessary to indicate that the performance of a procedure or service during the postoperative period was (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. This circumstance may be reported by adding the modifier 58 to the staged or related procedure.
Note: For treatment of a problem that required a return to the operating or procedure room (e.g., unanticipated clinical condition), see modifier 78.
Modifier 58 Fact Sheet
Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period:
It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). When this procedure is related to the first and requires the use of an operating room, it may be reported by adding modifier 78 to the related procedure. (For repeat procedures, see modifier 76).
Modifier 78 Fact Sheet
Unrelated Procedure by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period:
The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using the modifier 79. (For repeat procedures on the same day, see modifier 76).
Modifier 79 Fact Sheet
Unrelated E/M visit during a postoperative period, or on the same day as a procedure or another E/M visit.
Report modifier FT:
For critical care visits that are unrelated to the surgical procedure but performed on the same day; or
When critical care services provided during a global surgical period are unrelated to a surgical procedure.
Critical care services
MLN Matters article MM12550, Internet-Only updates for critical care E/M services
MLN Matters article MM12543, Internet-Only updates for critical care, split/shared E/M visits, teaching physicians and physician assistants
CMS, IOM Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.18