CurrentUCarePolicy N/A

-58 Staged or Related Procedure or Service Modifier

This reimbursement policy explains UCare's billing rules and appropriate/inappropriate uses for CPT modifier -58 across all UCare products; it affects providers submitting claims to UCare.

Policy Summary

PayerUCare

Policy-58 Staged or Related Procedure or Service Modifier

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateFeb 17, 2025

Key ActionAppend modifier -58 only for planned/staged procedures, procedures more extensive than the original, or therapy following a diagnostic surgical procedure; it will be allowed separately and start a new postoperative period.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

allproduct applicability

separatepayment effect

3 listedappropriate uses

3 listedinappropriate examples

Coverage criteria for modifier -58

Covered when ALL of the following are met:

Modifier -58 is allowed separately and begins a new postoperative period when appended to an eligible procedure or service.

Appropriate use (ALL of the following apply)

ONE of
- Planned prospectively or 'staged' at the time of the original procedure.
- Procedure was more extensive than the original procedure.
- Procedure performed for therapy following a diagnostic surgical procedure.

Policy Summary

PayerUCare

Policy-58 Staged or Related Procedure or Service Modifier

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateFeb 17, 2025

SourceLink

On This Page

Coding and postoperative period information

Example excluded CPT codeCPTNot Covered

67208

Destruction of localized lesions of the retina (example of a service to which -58 should not be appended because CPT definition includes multiple sessions)

Postoperative period reset

Postoperative period resetAppending modifier -58 to an eligible procedure or service is allowed separately and initiates a new postoperative period.

When not to resetDo not use -58 to report treatment of a complication that requires return to the operating room; that use is not appropriate for resetting the postoperative period.

Applies to same physicianModifier -58 is intended for staged or related surgical procedures performed by the same physician during the postoperative period.

Definitions and appropriate use scenarios

Modifier -58

DefinitionModifier -58 (Staged or Related Procedure or Service) indicates a procedure performed during the postoperative period that was planned or staged, more extensive than the original, or for therapy following a diagnostic surgical procedure.

PurposeFacilitates billing of staged or related surgical procedures done by the same physician during the postoperative period of the first procedure.

LimitationNot used to report treatment of a problem that requires a return to the operating room.

Appropriate use scenarios

Planned/stagedProcedure was planned prospectively or 'staged' at the time of the original procedure.

More extensiveProcedure was more extensive than the original procedure.

Therapy follow-upProcedure was performed for therapy following a diagnostic surgical procedure.

OpenPayer

-58 Staged or Related Procedure or Service Modifier

Coverage criteria for modifier -58

Coding and postoperative period information

Billing and appropriate use guidance for modifier -58

Definitions and appropriate use scenarios