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April 2020

Medicare Plus Blue PPO defines modifier 55 in update

Medicare Plus BlueSM PPO updated its claims information in October 2019 to include the following definition of modifier 55:

  • Indicate a physician, other than the surgeon, is billing for part of the outpatient postoperative care
  • Also, used by the surgeon when providing only a portion of the post-discharge postoperative care

According to the Modifier 55 Fact Sheet, the Centers for Medicare & Medicaid Services requires health care providers to file a beginning and end date for the postoperative care.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.
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