1. Our AMA (a) continues to strongly encourage the Centers for Medicare and Medicaid Services and private payers to recognize CPT codes, and follow guidelines and conventions as they relate to appending appropriate CPT modifiers 54, 55, and 56 to describe the segment of preoperative, surgical or postoperative care performed during the global period of a procedure when more than one physician delivers a specific segment of the care; and (b) will continue to educate physicians and their billing staff on how to appropriately use CPT codes, guidelines, and conventions when another physician provides services during the postoperative period.

2. The CPT Editorial Panel and the AMA/Specialty Society Resource Based RVS Update Committee will be encouraged to work with interested medical specialties to further address issues related to physician payment for the provision of postoperative care.

3. Our AMA reaffirms and will publicize policy D-70.955, which encourages private payers to recognize CPT codes and follow guidelines and conventions as they relate to appending appropriate CPT modifiers 54, 55, and 56 to describe the segment of pre-operative, surgical, or post-operative care performed during the global period of a procedure when more than one physician delivers a specific segment of the care.

Policy Timeline

BOT Action in response to referred for decision CMS Rep. 3, I-06 Reaffirmed and Modified: CMS Rep. 1, A-08 Reaffirmed: CMS Rep. 01, A-18