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.