In simple words: If you see a different doctor after your surgery than the one who performed it, the doctor who takes care of you afterwards may use a code called "modifier 55". This lets the insurance company know they should pay this doctor for the post-surgery care they provided.

Modifier 55, Postoperative Management Only, is used to indicate that a physician or other qualified healthcare professional provided only the postoperative component of a surgical package, while another provider performed the surgical procedure. This modifier facilitates appropriate payment allocation when the responsibility for postoperative care is transferred.

Example 1: A patient undergoes a complicated surgery performed by Dr. A. Due to unforeseen circumstances, Dr. A is unavailable for postoperative care, which is then managed by Dr. B. Dr. B would append modifier 55 to the surgical procedure code to indicate they provided only the postoperative management., A patient has surgery performed by a surgeon at a hospital far from their home. For convenience, the patient's primary care physician (PCP) manages the postoperative care. The PCP would use modifier 55 to bill for their services., A patient undergoes surgery performed by Dr. A. Partway through the typical postoperative period, the patient moves to a new location. Dr. B assumes postoperative care. Both Dr. A and Dr. B bill for the surgical code. Dr. A includes modifier 54 to indicate surgical care only. Dr. B includes modifier 55 to indicate postoperative management only. Both providers note the dates of care provided in the claim notes.

Documentation supporting the transfer of postoperative care is crucial. This includes documentation explaining why the original surgeon did not provide postoperative management (like relocation, surgeon unavailability, patient preference, etc.) and the date the postoperative care was transferred.

** The distribution of surgical package payment between providers is determined by individual payer policies. Each payer has its guidelines regarding the percentage of the global fee allocated to each component of the surgical package (preoperative, intraoperative, and postoperative care). Therefore, it's important to verify with each payer for specific billing instructions.