CurrentUCarePolicy N/A

-55 Post-Operative Management Only Modifier

Defines appropriate and inappropriate use, and payment rules, for billing the -55 modifier for post-operative services under UCare products, including Medicare Advantage, MHCP, and Commercial products; affects providers billing UCare.

Policy Summary

PayerUCare

Policy-55 Post-Operative Management Only Modifier

Policy CodePolicy N/A

Change TypeMinor — no material changes

Effective DateN/A

Next Review DateN/A

Key ActionAppend -55 modifier when a provider performs only post‑operative care for a surgical procedure with a 90‑ or 10‑day global period and the surgery and preoperative care were furnished by a provider from a different group practice.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

20%MHCP payment rate

90/10Applicable global periods

Medicare-basedFollows Medicare guidance

When -55 Post-Operative Management Only Modifier is Covered

Coverage criteria for -55 modifier

Covered when ALL of the following are met:

ALL of the following

Provider performs only post-operative care, and the surgical procedure and preoperative care were furnished by a provider from another group practice.
Modifier is appended only to surgical procedure codes.
The surgical procedure has a 90-day or 10-day global period.

ALL of the following

Not allowed if

Policy Summary

PayerUCare

Policy-55 Post-Operative Management Only Modifier

Policy CodePolicy N/A

Change TypeMinor — no material changes

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

Modifier and Applicable Global Periods

ModifierModifierCovered

-55	Post-operative management only modifier appended to surgical procedure codes to indicate only post-operative services were performed

Applicable global periods

Applicable global periods90-day or 10-day global surgical periods only

Applicable procedure typesOnly surgical procedures (append -55 to surgical procedure codes)

Eligibility conditionProvider must perform only post‑operative care while surgery and preoperative care were furnished by a provider from another group practice

Billing Actions and Requirements for Providers

Billing Rule

-55 Modifier: Post-Operative Management Only

Append the -55 modifier when the provider performed only the post-operative care associated with a surgical procedure that has a 90- or 10-day global period. The -55 modifier must be used only on surgical procedure codes; do not append to non-surgical services. When multiple providers from the same group practice participate in the global surgical package, the performing surgeon should bill the global package and the -55 modifier is not appropriate for other group members.

Apply only to surgical procedure codes with a 90- or 10-day global period
Use -55 when the billing provider furnished ONLY post-operative care
Do NOT use -55 for services other than surgical procedures with a global period
Do NOT use -55 when care during the global period was furnished by multiple providers in the SAME group practice
When different providers from different group practices provide the surgery and post-operative care, the post-operative provider may append -55
When a group practice’s members both perform the surgery and provide post-op care, bill the global surgical package; list the surgeon as the performing physician

Definitions and Product Information

-55 modifier — definition and use

Definition of -55 modifierAppended to a surgical procedure to indicate only the post‑operative services associated with the global surgical package were performed by that clinician

When to appendAppend -55 only when the provider performed only post‑operative care and the surgery and preoperative care were furnished by a provider from another group practice

Not appropriate forNon‑surgical services or situations where multiple providers in the same group practice furnished care during the global period

Product information

Scope of product informationBase policy information applies to all UCare products

Variation noteProduct‑specific payment information may vary and is detailed separately for each product

ApplicabilityUCare Medicare Advantage and Commercial products follow Medicare guidelines for payment unless product terms specify otherwise