CurrentPremera BluecrossPolicy N/A

Modifier 58 Staged or Related Procedure or Service by Same Physician or Other Qualified Healthcare Professional during Postoperative Period

Defines when Premera recognizes CPT modifier 58 on professional claims to indicate staged or related subsequent pre-planned procedures performed during the global postoperative period by the same physician or other qualified healthcare professional; applies to Premera and affiliated lines of business.

Policy Summary

PayerPremera Bluecross

PolicyModifier 58 staged or related procedure during postoperative period

Policy CodePolicy N/A

Change TypeAnnual reviewno material changes

Effective DateN/A

Next Review DateSep 4, 2024

Key ActionDocument prospective plans in the member's medical record when billing modifier 58 to indicate staged return to the operating room.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Modifier 58Resets global period

One-or-more sessionsExclusion examples

78/79Mutually exclusive

CMS-1500Form

When Modifier 58 Is Recognized

When to use Modifier 58

Modifier 58 is recognized when a staged or related pre-planned procedure is performed during the global period by the same physician or other qualified healthcare professional.

Prospective documentation in the member's medical chart must indicate plans for a staged return to the operating room during the global period of the initial surgery.

Documentation requirement

Appending modifier 58 to a subsequent surgical service breaks the global period of the initial procedure and resets the global period based on the subsequent staged procedure.

Billing effect

Do not use modifier 58 on CPT procedure codes described as 'one or more sessions' (examples: 41530, 66762, 67208, 67210, 67218, 67220, 67229).

Exclusion for specific CPT codes

Modifier 58 should never be billed with modifier 78 or modifier 79 on the same service.

Policy Summary

PayerPremera Bluecross

PolicyModifier 58 staged or related procedure during postoperative period

Policy CodePolicy N/A

Change TypeAnnual reviewno material changes

Effective DateN/A

Next Review DateSep 4, 2024

Key ActionDocument prospective plans in the member's medical record when billing modifier 58 to indicate staged return to the operating room.

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.

Applicable Codes and Related Modifiers

Excluded CPT codes (examples)CPTNot Covered

41530	Examples of CPT procedure codes described as 'one or more sessions' where modifier 58 should not be used
66762	Examples of CPT procedure codes described as 'one or more sessions' where modifier 58 should not be used
67208	Examples of CPT procedure codes described as 'one or more sessions' where modifier 58 should not be used
67210	Examples of CPT procedure codes described as 'one or more sessions' where modifier 58 should not be used
67218	Examples of CPT procedure codes described as 'one or more sessions' where modifier 58 should not be used
67220	Examples of CPT procedure codes described as 'one or more sessions' where modifier 58 should not be used
67229	Examples of CPT procedure codes described as 'one or more sessions' where modifier 58 should not be used

Related modifiersModifier

Modifier 76	Repeat Procedure by the Same Provider — use when basic procedure repeated after the original
Modifier 78	Unplanned return to the Operating Room for a Related Procedure — use for treatment of a problem or complication that requires an unplanned return to the operating room for a related procedure
Modifier 79	Unrelated Procedure/Service by the Same Provider During Postoperative Period — use for an unrelated surgical procedure during the postoperative period

Billing and Documentation Requirements

Documentation Required

Document prospective plans for staged return to the OR

Documentation in the member's medical chart must indicate prospective plans for returning the patient to the operating room for additional procedures during the global period of the initial surgery when billing modifier 58.

Billing Rule

Do not bill modifier 58 with 78 or 79 on the same service

Do not append modifier 58 together with modifier 78 or 79 on the same service; modifier 58 should never be billed with modifier 78 or 79.

Modifier Definitions

Modifier 58 — definition

DefinitionAppended to indicate a staged or related subsequent pre-planned procedure performed during the global period by the same physician or other qualified healthcare professional; appending modifier 58 breaks the global period of the initial procedure and resets the global period based on the subsequent staged procedure.

Documentation requirementMedical record must indicate prospective plans for returning the patient to the operating room for additional procedures during the global period of the initial surgery.

Exclusion examplesDo not use modifier 58 on CPT codes described as 'one or more sessions' (examples: 41530, 66762, 67208, 67210, 67218, 67220, 67229).

Modifier 76 — definition

DefinitionIndicates repeat procedure by the same provider when a basic procedure or service is repeated after the original.

When to useUse modifier 76 when the basic procedure or service is repeated by the same physician or other qualified healthcare professional after the original procedure.

Relation to Modifier 58Modifier 76 is the appropriate alternative when the service is a repeat, rather than a staged subsequent pre-planned procedure (Modifier 58).

Modifier 78 — definition

DefinitionIndicates an unplanned return to the operating room for a related procedure during the postoperative period.

When to useAppend modifier 78 for treatment of a problem or complication that requires an unplanned return trip to the operating room for a related surgical procedure by the same provider during the postoperative period.

Mutual exclusivityModifier 78 should not be used on the same service with modifier 58 (Modifier 58 is for planned/staged procedures).

Modifier 79 — definition

DefinitionIndicates an unrelated procedure or service by the same provider during the postoperative period.

When to useAppend modifier 79 for an unrelated surgical procedure performed by the same physician or other qualified healthcare professional during the postoperative period.

Mutual exclusivityModifier 79 should never be billed with modifier 58 on the same service.