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Modifier 56 and Referrals

  1. Default Modifier 56 and Referrals
    Medical Coding Books
    If a patient comes to your office for a pre-op exam and your not part of the surgeon's group, can you use modifier 56? If yes, do you need a referral?

  2. Default
    yes the modifier 56 can be used and you don't need a referral

  3. #3
    Milwaukee WI
    Default No referral needed, but you DO need the CPT
    You don't need a referral, but you will need to know what primary CPT the surgeon will be using for the surgery. You code THAT CPT with the -56 modifier. The surgeon will use a -54 modifier. The payer will split the "global fee" accordingly between the two physicians.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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