CurrentUCarePolicy N/A

Use of -54 Surgical Care Only modifier

Defines when and how the -54 modifier (Surgical Care Only) should be used for surgical procedure billing across UCare products, and describes product-specific payment guidance. Affects physicians and billing staff submitting professional surgical claims to UCare.

Policy Summary

PayerUCare

PolicyUse of -54 Surgical Care Only modifier

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateMar 31, 2025

Key ActionAppend -54 only to surgical procedure codes when the surgeon performs the surgery and preoperative care but relinquishes all or part of postoperative care to a provider from another group practice.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

allproduct applicability

Medicare-guidedpayment methodology

80%MHCP primary payer

10/90dglobal period requirement

Coverage and Payment Criteria

Coverage and payment criteria

Conditions under which the -54 modifier is acceptable and payment rules by product:

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

Appropriate use requires the surgeon performed the surgery and preoperative care and relinquished postoperative care to a provider from another group practice.

Do not append -54 when care during the global period was furnished by multiple providers in the same group practice or when appended to non-surgical services.

UCare Medicare Advantage and Commercial products follow Medicare guidelines; payment for eligible services is based on the combined pre- and intraoperative percentages as defined by Medicare.

Policy Summary

PayerUCare

PolicyUse of -54 Surgical Care Only modifier

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateMar 31, 2025

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 Guidance for the -54 Modifier

Billing Rule

Billing guidance for -54 modifier

Append the -54 modifier only when the surgeon performs the surgical procedure and preoperative care but relinquishes all or part of postoperative care to a provider from another group practice. Do not use -54 for non-surgical services or when postoperative care is shared within the same group practice. The surgeon who performed the operation should be listed as the performing physician on the claim.

Apply -54 only to surgical procedure CPT/HCPCS codes with a 90- or 10-day global period.
Use -54 when the surgeon performs the procedure and pre-operative care and relinquishes postoperative care to a provider from another group practice.
Do NOT append -54 to services that are not surgical procedures or that lack a 10- or 90-day global period.
Do NOT append -54 when multiple providers in the same group practice furnish care during the global period; instead bill the global surgical package and list the operating surgeon as the performing physician.

Key Definitions

inv-05: -54 Surgical Care Only modifier — definition

Definition-54 indicates the surgeon performed the surgical procedure and is relinquishing all or part of the postoperative care to another provider.

Scope within group practiceWhen different providers in the same group participate in care, the global surgical package should be billed and the surgeon who performed the operation should be listed as performing physician.

Components of surgical servicesSurgical services include pre-operative, intraoperative, and postoperative care.

inv-06: Appropriate use

Appropriate use summaryAppend the -54 modifier to surgical procedure codes only when the surgeon performs only the surgical procedure and pre-operative care and relinquishes postoperative care to a provider from another group practice.

Not for non-surgical servicesDo not append -54 to services other than surgical procedures with a 10- or 90-day global period.

Global period requirementApplicable only when the surgery has a 90- or 10-day global period.

OpenPayer

Use of -54 Surgical Care Only modifier

Coverage and Payment Criteria

Modifier and Global Period Requirements

Billing Guidance for the -54 Modifier

Key Definitions