Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or postoperative management. Both AMA/CPT guidance as summarized by AAPC and CMS’s Global Surgery Booklet describe modifier 54 for cases where the surgeon provides only the surgical portion and transfers pre/postoperative care to another practitioner (the receiving provider typically reports the same procedure with modifier 55 for postoperative management). Use includes formal or anticipated transfers of postoperative care (for example, a traveling surgeon who performs an operation but expects local follow‑up), and common emergency department fracture reductions where the ED physician performs the procedure and refers follow‑up to orthopedics.

Billing impact: payers commonly split the global surgical package between the intraoperative provider and the postoperative provider; many references note the operating surgeon often receives the largest share of RVUs (commonly cited around 70% in AAPC guidance), with the remainder paid to the postoperative caregiver. Payer rules vary, so coordination between providers and use of the same CPT code/date with the appropriate modifiers (54 for surgical only, 55 for postoperative management) is essential to avoid denials. Modifier 54 does not apply to assistant‑at‑surgery services or ASC facility fees, and it should not be used when no transfer of care occurs and follow‑up is unrelated or incidental (those situations are billed with standard E/M services instead).