Karalea88
Contributor
Can same group providers with same Tax ID report modifiers 54 and 55 on procedures with 90 day global? Should the surgery be billed as global?
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Wiki Modifier 54 and 55-- help
- Thread starter Karalea88
- Start date
thomas7331
Guest
In theory you could bill this way, but it doesn't really make sense and could potentially cause problems with the payers. These modifiers are intended for a transfer of care to a provider in a different practice for post-operative care, which enables the payer to divide the global payment up and direct each part of the reimbursement to two separate business entities. If both providers are in the same group, you're asking the payer to separate the payment and issue two checks instead of one, which means you will have the additional administrative costs involved in coding, charging, billing, follow-up and collecting for two payments instead of one. If you need to separate your costs within your practice, in my opinion it's better to bill globally and to track this internally and to leave the payer out of the picture.
amyjph
True Blue
Agree with Thomas. I don't understand the thinking behind doing this and yes, it would/could cause issues.
Karalea88
Contributor
Thank you both for your feedback 
This helps make it clear!!
This helps make it clear!!