Modifier 54 identifies surgical care only

Blue Cross Blue Shield of Michigan is updating its payment policy for surgical services in March 2023.

When no follow-up care is provided, modifier 54 (surgical care only) should be added to the surgical procedure code with a global period of 10 or 90 days. Payment will be reduced when only the surgical procedure is rendered. The reduction will be based on the individual procedure code values in the Centers for Medicare & Medicaid Services’ physician fee schedule.

If modifier 54 isn’t on the claim in instances where surgery is performed in the emergency department by a trauma surgeon or an emergency medicine professional provider, it will be added.