When a physician performs the pre-operative care and evaluation only (another physician performs the surgical procedure), the pre-operative component may be identified by adding modifier 56 to the appropriate surgical CPT codes.

Do not bill the global surgical code when pre-operative services are the only services rendered.

Report modifier 56 when:

• The CPT code has a global surgical package; if there is no global package, the appropriate E&M service may be more appropriate to report.
• It is known that the surgical services/post-operative care will be performed by or transferred to another health care provider.

Code review

We review historical data prior to reimbursing claims submitted with modifier 56 to validate partial services were rendered to avoid duplicate reimbursement.

If an unmodified surgical code is reported and global payment made, claims submitted with a modifier 56 will be denied as inclusive or redundant to the global surgical payment.