How to Report Medicare Split Post-Operative Care

Q. What is the correct way to report split post-operative care on a Medicare claim?

A. Texas Medicare contractor Novitas Solutions says to report split care as follows:

  • Report the date of service using the date of the surgical procedure.
  • Report the procedure code for the surgical procedure, followed by modifier 55.
  • Report the range of dates that you provided the post-operative care in the procedure description (narrative) field on electronic claims, and block 19 on the CMS-1500 claim form. Novitas does not need each date, only the range of dates.
  • Both the surgeon and the physician(s) providing the post-operative care must keep a copy of the written transfer agreement in the beneficiary’s medical records.
  • Where physicians agree on the transfer of care during the global period, use the following modifiers:
    • Modifier 54 for surgical care only, or
    • Modifier 55 for postoperative management only.
     

Find details in the A/B Reference Manual, Chapter 22 on the Novitas Solutions website.

Published June 20, 2013 


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