Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in split‑care scenarios when one clinician handles preoperative optimization or clearance and another performs the surgery. Medicare/CMS treats the preoperative component as part of the global surgical package and generally does not pay separately for services reported only with Modifier ‑56; CMS allocations in split‑care models assign 0% to Modifier ‑56, while surgical and postoperative components receive the typical percentages (e.g., ~80% and ~20%). Commercial payer policies vary—some plans may reimburse a portion of the global fee (examples cited around 15% in payer‑specific contexts), so always verify the specific payer policy before relying on separate payment.

When Medicare will not separately reimburse preoperative-only services, clinicians should consider billing an appropriate E/M or consult code when the service meets criteria, rather than expecting separate payment for a surgical CPT code appended with Modifier ‑56. Improper use of Modifier ‑56 can lead to denials or audits, so documentation should clearly show that the provider performed only preoperative management and that any separate E/M or consult billing meets payer rules.