Billing Guidelines

“Co-management” of Postoperative Care for Cataract Surgery

(CPTs 66821, 66982, 66983, 66984)

Providers should follow Medicare billing guidelines relative to practitioners who share postoperative management with another practitioner following cataract surgery (CPT 66821, 66982, 66983, 66984) where Modifier 55 (post-operative management only) is relevant.

The Alliance has noticed inconsistencies in billing for these services, therefore, these guidelines are offered to ensure appropriate reimbursement.

 

Billing for Part of the Global Surgery Package

  • If the physician who performs surgery relinquishes care after the surgery, the claim should report the date of surgery and the surgical procedure code with modifier 54 (surgical care only).
  • If the physician performing the surgery continues to care for the patient for some period following the surgery, the claim should report:
    1. The date of surgery with the surgical procedure code and modifier 54; and
    2. Separate claim line with the date of surgery, surgical procedure code and modifier 55 (post-operative care) with a unit of 1. The dates during the post-operative period for which the practitioner was responsible for care must be included on the claim form. Field 19 on the CMS-1500 claim form must indicate the date from and date to. On the electronic file, the fields “assumed care date” and “relinquished care date” should be completed.
  • When billing for post-operative care management only, modifier 55 should be used with the surgical procedure code and report unit of 1. The dates during the post-operative period for which the practitioner was responsible for care must be included on the claim form. Field 19 on the CMS-1500 claim form must indicate the date from and date to. On the electronic file, the fields “assumed care date” and “relinquished care date” should be completed.

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