CurrentAspirus ArisePolicy N/A

-54 Surgical Care Only Modifier

Rules for appending the -54 modifier on surgical procedure claims for Aspirus Health Plan Medicare Advantage products, describing appropriate and inappropriate uses and payment basis. Affects surgeons and billing staff submitting claims to Aspirus Arise Medicare Advantage.

Policy Summary

PayerAspirus Arise

Policy-54 Surgical Care Only Modifier

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateFeb 17, 2025

Key ActionAppend -54 to surgical procedure codes when the surgeon performs only the surgery and pre-operative care and relinquishes postoperative care to another provider.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

90- or 10-dayglobal surgical periods referenced

Medicare-basedpayment basis

Medicare Advantageproduct applicability

When -54 Surgical Care Only Modifier Is Appropriate

Use and payment criteria for -54 modifier

Covered when ALL of the following conditions are met:

Modifier -54 may be appended only to surgical procedure codes with a 90- or 10-day global period.

The surgeon performs only the surgical procedure and pre-operative care and relinquishes remaining postoperative care to a provider from another group practice.

The -54 modifier is appended only to surgical procedure codes (not to non-surgical services).

Exceptions / Inappropriate uses

Do not append -54 to any service other than a surgical procedure with a 90- or 10-day global period.

Policy Summary

PayerAspirus Arise

Policy-54 Surgical Care Only Modifier

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateFeb 17, 2025

Key ActionAppend -54 to surgical procedure codes when the surgeon performs only the surgery and pre-operative care and relinquishes postoperative care to another provider.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Billing Actions and Responsibilities

Billing Rule

When and how to bill with modifier -54

Append modifier -54 to surgical procedure codes only when the surgeon performs the surgery and pre-operative care and relinquishes all or part of the postoperative care to another provider from a different group practice. Do not append -54 for services other than surgical procedures or when multiple providers in the same group practice share care; in that case bill the global surgical package and list the operating physician as the performing physician.

Append -54 only to surgical procedure codes with a 90- or 10-day global period.
Do not use -54 when care during the global period was furnished by multiple providers in the same group practice; instead bill the global surgical package and list the operating physician as performing physician.
Appending -54 indicates the surgeon performed the procedure and is relinquishing postoperative care to another provider.

Key Definitions

-54 modifier

-54 modifier definitionWhen appended to a surgical procedure, indicates the provider performed the surgery and is relinquishing all or part of postoperative care to another provider.

Billing when same group participatesIf different providers in the same group practice participate in care, bill the global surgical package and list the operating physician as the performing physician.

Modifier use contextUsed only on surgical procedures with global periods (e.g., 90‑ or 10‑day) where postoperative care is transferred to another provider.

Surgical services (global package)

Global package componentsSurgical services (global package) include pre‑operative, intraoperative, and postoperative care.

Performing physician listingWhen multiple providers in a group participate, bill the global package and list the surgeon as the performing physician.

Relation to -54The -54 modifier is used when the surgeon performs the procedure and pre‑operative care but relinquishes postoperative care to another provider.

OpenPayer

-54 Surgical Care Only Modifier

When -54 Surgical Care Only Modifier Is Appropriate

Modifier and Payment Basis

Billing Actions and Responsibilities

Key Definitions