For claims with dates of service on or after Jan. 1, 2027, ophthalmologists billing post-operative care using Modifier 55 must follow updated claim submission requirements.
What's changing?
When submitting applicable claims with Modifier 55, ophthalmologists should:
- Report 1 unit in the units field
- Include the post-operative date span in the claim notes section
- Continue to bill the appropriate surgical CPT code with Modifier 55 when only post-operative services were provided
Why is this changing?
We’re updating claim processing to align with Epic. Modifier 55 claims will no longer be reimbursed on a per-day basis. Instead, claims will be processed based on the submitted post-operative date span and reimbursed according to the applicable post-operative portion of the global surgical package.
Reminder
Modifier 55 should only be used when a provider renders the post-operative portion of a procedure that has a global surgical period. The date of surgery should be reported as the date of service on the claim.
More information
Get more information on using Modifier 55 for post-operative services in our Provider Manual.