Modifier 55: Postoperative (Post-Op) Care Only

Definition

Modifier 55 is used when a provider performs only the post-operative phase of a procedure that has a global surgical package. The post-operative phase includes all visits and care from the day after surgery through the end of the global period (typically 0 or 90 days depending on code). Another provider performs the intraoperative and pre-operative phases. Modifier 55 indicates responsibility for post-op management only.

When to Use

Primary care physician manages post-operative follow-up (55 modifier) after surgeon performs total knee replacement (27447-54 by orthopedic surgeon)
Hospital-based hospitalist manages post-operative recovery after surgeon performs coronary artery bypass (33510-54); cardiologist bills 55 for outpatient post-op
Group practice surgeon performs appendectomy (44960-54); different surgeon in same group manages post-operative visits (44960-55)
Visiting surgeon does cataract surgery (66984-54); local ophthalmologist bills 66984-55 for post-operative exams

Documentation Requirements

Document post-operative visits and management in chart. Note date of surgery (by other provider) and global period end date. Document all post-op care provided: wound checks, suture removal, medication management, complication monitoring. Ensure only post-operative services are documented, not duplication of operative report or pre-operative evaluation. Each visit note should reference the global period dates.

Payer-Specific Rules

Payer	Acceptance	Common Denials	Notes
Medicare	Accepted; split global fee	CO-20: Charge exceeds fee schedule	Pay only post-operative RVU portion (typically 10-20% of global). Require visit documentation.
Aetna	Accepted; requires coordination	CO-4: Service bundled	Pay post-op portion. Require other provider operative documentation and dates.
United Healthcare	Accepted with coordination	CO-56: Information incomplete	Pay post-op portion. Deny if surgeon already billed post-op care.
Cigna	Accepted with documentation	CO-20: Charge exceeds fee schedule	Will pay post-op portion. Require surgery date and operative surgeon documentation.
Humana	Accepted; standard post-op split	CO-55: Post-op care included	Pay post-operative RVU. Deny if overlap with surgeon post-op billing.

Related Modifiers

54 – Intraoperative care only. Used by surgeon who performs operative portion.
56 – Pre-operative care only. Used by provider doing pre-operative evaluation/clearance.
25 – Significant E/M. Use if separate E/M (e.g., for new problem) during post-op period.

Common Denials

CARC Code	Reason	Primary Cause
CO-20	Charge exceeds fee schedule	Billed full code charge; must bill reduced post-op-only fee.
CO-4	Service bundled	Surgeon already billed complete global package; cannot also bill 55.
CO-55	Post-op care included	Post-operative care already included in operative surgeon's billing.

FAQ

What RVU percentage do I get for modifier 55?

Medicare typically 10-20% of global RVU (post-operative portion). Varies by code.

Can I bill multiple post-op visits during the global period?

No. Global period package includes all post-op visits. Individual visit codes not billed; 55 covers entire post-op phase.

What if a complication occurs during post-op phase?

Complication management is included in global package. Unless separate E/M for unrelated condition, no additional code.

Prevent These Denials

Altair's co-pilot validates post-operative modifier usage and documentation before submission.

Related Resources

This reference is current as of 2026-03-23. Payer policies change. Always verify against the payer's latest policy documentation.

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