Modifier 55 payment reduction

aprillerowland

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Does anyone know what Medicare pays when you use a modifier 55? I've searched everywhere. I know it's discounted due to only assuming post op care but trying to find out how much. Thank you!
 

thomas7331

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Medicare pays a percentage of the global fee for the code which you can find by looking up the specific code on the physician fee schedule or PFS relative value file. There are columns for Pre-op, Intra-op and Post-op that will tell you the percentage of the fee allocated to each category and it can range anywhere from 7% to 23% of the global fee.
 
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