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Append Modifier FT for Unrelated Critical Care Services

Append Modifier FT for Unrelated Critical Care Services

On Jan. 14, coders and billers gained insight into proper use of novel HCPCS Level II modifier FT Unrelated evaluation and management (e/m) visit during a postoperative period, or on the same day as a procedure or another e/m visit. (report when an e/m visit is furnished within the global period but is unrelated, or when one or more additional e/m visits furnished on the same day are unrelated.


Update (March 3, 2022): The definition for modifier FT was revised in the HCPCS Level II code set second quarter update to:

Unrelated evaluation and management (e/m) visit on the same day as another e/m visit or during a global procedure (preoperative, postoperative period, or on the same day as the procedure, as applicable). (report when an e/m visit is furnished within the global period but is unrelated, or when one or more additional e/m visits furnished on the same day are unrelated)


While the new modifier took effect Jan. 1, the Centers for Medicare & Medicaid Services (CMS) only recently provided some specifics about its application. Read on to find out what CMS had to say about using modifier FT when billing for separate payment of critical care services provided during, and unrelated to, global surgical procedures.

Take a Closer Look at Modifier FT

Simply put, you should append modifier FT to report an unrelated evaluation and management (E/M) service during the global period of a procedure or on the same day as another E/M service. Doing so indicates that the E/M service performed is not related to either the operative procedure or to the other E/M service provided on that same day.

Unrelated Critical Care Warrants Modifier FT

Patients may require critical care visits during the global period of a procedure, whether preoperative, same day, or during the postoperative period. In some cases, the CPT® codes that have a global surgical period include pre- and postoperative critical care services.

With the release of updated policies in January, CMS provides authoritative guidance explicitly stating that Medicare will allow separate payment for unrelated critical care services furnished on the same day or during the global surgical period. Proper reporting of these services includes appending modifier FT to the critical care CPT® code(s).

The key here is unrelated. For Medicare to cover services described by CPT® codes 99291 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes and +99292 (each additional 30 minutes) — when performed before or after surgery, or on the same day as a procedure — the two services must be distinct and the documentation should demonstrate how they stand alone.

CMS Weighs In

Per the latest guidance, in those cases where a critical care visit is unrelated to the procedure with a global surgical period, critical care visits may be paid separately in addition to the procedure if certain conditions are met. CMS allows payment for preoperative/postoperative critical care “in addition to the procedure if the patient is critically ill (meets the definition of critical care) and requires the full attention of the physician, and the critical care is above and beyond and unrelated to the specific anatomic injury or general surgical procedure performed (for example, trauma, burn cases).” In such cases append modifier FT.

Change Request 12543, released Jan. 14, clarifies that if the surgeon fully transfers care to an intensivist (and the critical care is unrelated), they need to use modifiers 54 Surgical care only and 55 Postoperative management only to indicate the transfer of care. The surgeon reports modifier 54. The intensivist accepting the transfer of care reports both modifier 55 and modifier FT. As usual, medical record documentation must support the claims.


See MLN Matters 12550 for more information on updates to Chapter 12 of the Medicare Claims Processing Manual.

For additional guidance, see the Internet-Only Manual Updates for Critical Care Evaluation and Management Services, MLN Matters 12550.

Stacy Chaplain

About Has 127 Posts

Stacy Chaplain, MD, CPC, is a development editor at AAPC. She has worked in medicine for more than 20 years, with an emphasis on education, writing, and editing since 2015. Chaplain received her Bachelor of Arts in biology from the University of Texas at Austin and her doctorate in medicine from the University of Texas Medical Branch in Galveston. She is a member of the Beaverton, Ore., local chapter.

11 Responses to “Append Modifier FT for Unrelated Critical Care Services”

  1. Matt Beatty says:

    Quick question, can you clarify if this is replacing or in addition to the CMS 27 modifier for the Hosptial setting? “Modifier 27 is for hospital/outpatient facilities to use when multiple outpatient hospital evaluation and management (E/M) encounters occur for the same beneficiary on the same date of service. “

  2. Stacy Chaplain says:

    Matt, there was no mention of modifier 27 in the updates/CMS documents referenced. Please post your question in our forums or utilize our Ask an Expert service.

  3. Brenda Wilson says:

    It there a HCC book available with all this good information

  4. Rajavinitha says:

    Do we need to append 24 modifier for the same claim that warrants FT modifier. Could anyone guide

  5. Stacy Chaplain says:

    It depends on the specific circumstances. Report modifier FT: For critical care visits that are unrelated to the surgical procedure but performed on the same day; or when critical care services provided during a global surgical period are unrelated to a surgical procedure. Appropriate Usage of Modifier 24: Append to the E/M procedure code (other than critical care services); Use for E/M starting the day after a procedure; Documentation indicates the service was exclusively for treatment of the underlying condition and not for post-operative care. Do not use modifier 24 with critical care codes (99291 or 99292) for services January 1, 2022, and after (https://www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resources/modifier-24/).

    Here are some links that further clarify use of these modifiers:
    https://www.cms.gov/files/document/r11287cp.pdf
    https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144547

  6. Deb Rumery says:

    Hello,

    Confusion abounds on whether or not the FT modifier is restricted to use on Critical Care codes vs other E/M codes. CMS seems to lean to critical care only but the description does the overarching E/M visit verbiage. Is there any clear guidance on this or do payers all take a stab at implementing to what suits them?

  7. Stacy Chaplain says:

    See MLN Matters 12550 for more information on updates to Chapter 12 of the Medicare Claims Processing Manual.

    For additional guidance, see the Internet-Only Manual Updates for Critical Care Evaluation and Management Services, MLN Matters 12550.


    The article mentions and provides links to the guidance release by CMS. If you’re unsure, it’s best to check with your payer to verify what their specific polices are.

  8. Madhukar says:

    It is applicable for Medicare or for all payers

  9. Renee Dustman says:

    This is Medicare guidance but commercial payers often follow same guidance. You must check commercial policies to confirm.

  10. Alexandra says:

    does this mean that we should not use 24 and FT together for critical care during global ( only FT)?
    I understand that this is only for critical care. What about subsequent visits during global period? Do we use 24 and FT or FT only? Thanks

  11. Stacy Chaplain says:

    Alexandra, for CY 2022, CMS has added a new billing modifier for use during critical care visits that occur during a global surgical period but are unrelated to the procedure and for critical care visits on the same day as another E/M visit if the critical care visit comes after. Modifier FT can be used on critical care codes 99291 and 99292. This change allows additional billing during the global surgical period to recognize and reflect events and care extending beyond routine peri-operative care and complications. Note that these encounters must be unrelated to the surgical procedure performed. In addition, these encounters must not be related to any other surgical procedure and therefore cannot be combined with modifiers 79 or 24.
    You should report modifier FT:
    – For critical care visits that are unrelated to the surgical procedure but performed on the same day; or
    – When critical care services provided during a global surgical period are unrelated to a surgical procedure.
    For more information, see https://www.cms.gov/files/document/mm12543-internet-only-manual-updates-iom-critical-care-split-shared-evaluation-and-management-visits.pdf

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