payment formula when we apply modifier 54

Modifier 54

54 Modifier Surgical Care Only: One physician performs a surgical procedure and another provides preoperative and/or postoperative management. The Medicare Physician Fee Schedule Database (MPFSDB) gives percentages that apply to pre and intraoperative services.

Use the 54 modifier when one physician performs a surgical procedure and another provides preoperative and/or postoperative management, or the postoperative management is split between the surgeon and another practitioner. Place this modifier after the CPT code for the surgeon who is doing the surgery and not the entire patient follow-up.

Modifier 54 Example
When a 54 modifier is used, the allowance is based on the preoperative and intraoperative percentages of the global allowance.
Code       Global Period Preop % Intraop % Postop  % Allowance
66984-54 90               10%        70%       20%   $593.73 x 80% = $474.98

*80% = Preop + Intraop percentage