CMS Pub. 100-04, ch. 4, § 250.17

Submitted with Modifier 54 and/or 55

(Rev. 2574, Issued: 10-26-12 , Effective:01-01-13 , Implementation:01-07-13)

Global surgical procedures rendered by a physician that has reassigned their billing rights

to a CAH Method II provider is payable by Medicare only when billed on an 85x type of

bill (TOB) with revenue code (RC) 096x, 97x, and/or 98x and modifier 54 (surgical care

only) and/or 55 (postoperative management only).

There are occasions when more than one physician provides services included in the

global surgical period, i.e., when the physician who performs the surgical procedure does

not furnish the follow-up care. If this occurs, payment for the postoperative or post-discharge care should be split between the physicians when they agree on the transfer of

care.

When more than one physician furnishes services that are included in the global surgical

package, the sum of the amount approved for all physicians may not exceed what would

have been paid if a single physician provides all services (except where stated policies,

e.g., the surgeon performs only the surgery and a physician other than the surgeon

provides preoperative and postoperative care, result in payment that is higher than the

global allowed amount).

CAH Method II providers may review the Global Surgical pricing rules in Pub. 100-04,

Chapter 12, sections 40.1-40.5.