Reimbursement policy update: Split-care surgical modifiers
Reimbursement is based on a percentage of the fee schedule or contracted/negotiated rate for the surgical procedure. Currently:
- Modifier 54 (surgical care only) is reimbursed at 80%.
- Modifier 55 (postoperative management only) is reimbursed 20%.
- Anthem Blue Cross does not allow separate reimbursement for Modifier 56.
Effective March 1, 2021, Anthem Blue Cross will continue to reimburse on a percentage of the fee schedule or contracted negotiated rates for the surgical procedure. However, the following rates have been amended:
- Modifier 55 (postoperative management only) will be reimbursed at 30%.
For additional information, review the Split-Care Surgical Modifiers reimbursement policy at https://mediproviders.anthem.com/ca.
December 2020 Anthem Blue Cross Provider News - California