Reimbursement Policy Update: Split-Care Surgical Modifiers, effective May 1, 2020

Category: Cal MediConnect

Anthem Blue Cross (Anthem) has updated the split-care modifier percentages.

 

Currently, Anthem allows reimbursement of surgical codes appended with split-care modifiers. Reimbursement is based on the following percentages:

• Modifier 54 (surgical care only): 70%
• Modifier 55 (postoperative management only): 30%

 

Separate reimbursement for Modifier 56 is not allowed.

 

Effective May 1, 2020, Anthem will continue to allow reimbursement of surgical codes appended with split-care modifiers reimbursement, but reimbursement will be based on the following percentages:

• Modifier 54 (surgical care only): 80%
• Modifier 55 (postoperative management only): 20%

 

Separate reimbursement for Modifier 56 is not allowed.

 

Please visit https://mediproviders.anthem.com/ca to view the Split-Care Surgical Modifiers reimbursement policy for additional information regarding percentages and reimbursement criteria.