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Thread: Confused on Modifier 54

  1. #1

    Default Confused on Modifier 54

    AAPC: Back to School
    I'm a little confused on the correct usage of modifier 54. Is this modifier limited to only procedures with a 90 day global period, or can it be used for procedures with a 10 day global period?

    For example, if we had a patient (not our patient) come into the office with a fracure to his/her hand and we repaired it, and applied a cast,but we told the patient to follow-up with his/her PCP, can we append modifier 54 to the fracture code?

    This is a non-Medicare, so we do not have to have a request for transfer of care, correct?

    Last edited by dballard2004; 04-28-2010 at 10:00 AM.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    54 can be used for any procedure that has a global post operative time frame. It will indicate that your physician performed the surgical service only.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    Thanks so much!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Let the PCP know

    Be sure to let the CPC know that s/he should also bill the same fracture care code with -56 modifier.

    F Tessa Bartels, CPC, CEMC

  5. #5


    I see because the preop was also done! Perfect! If the fracture was done on the right hand, would we also use RT modifier along with 54 and 56? Thanks as always!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

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