Medicare Global Surgical Care Split Rules Extended to CAHs

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  • September 4, 2012
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If you’re a critical access hospital (CAH) method II provider, your Medicare contractors must now apply payment methodology used for global surgical split care.
According to Centers for Medicare & Medicaid (CMS) rules for professional claims, outlined in CMS Transmittal CR7872, the global surgical care fee may be split if one physician provides the surgical portion of a procedure and another physician provides postoperative management. In such a case (and assuming that the physicians agree on the transfer of care), each physician would bill the identical, appropriate CPT® code to describe the surgical procedure; the physician reporting the surgical care would append modifier 54 Surgical care only, and the physician providing postoperative management would append modifier 55 Postoperative management only.
As explained by MLN Matters® Number: MM7872, “There are no policy changes attached to CR7872, which simply applies the logic currently used when split global surgery services are billed on professional claims to those services when billed by a Method II CAH to an FI or MAC on type of bill 85X with revenue codes of 96X, 97X, or 98X.”
Medicare uses payment policy indicators from the Medicare Physician Fee Schedule (MPFS) to determine the surgical care only and postoperative percentages payments. Except where explicitly allowed by policy when more than one physician furnishes services included in the global surgical package, the sum of the amount approved for all physicians may not exceed what would have been paid if a single physician provides all services.

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