Modifier 55 help please

melbiv

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Our Rural Health Clinic has taken over an orthopedic practice. The original clinic has billed their surgeries with modifier 54.

My question is:
What money amount do we attach to our charge for the postoperative care?

I know that we use the surgical cpt code with modifier 55 appended as well as the date range of the surgical global we are billing for. I have read some information that we bill with the total amount for the surgical pro fee and the insurance will appropriately reduce the charge.

Am I correct?
 

mitchellde

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Typicall the 55 modifier is calculated to be 15% of the global allowable at the maximum. Then for a single encounter you divide that number by the number of days in the global.
 
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