Orthopedic Billing Services

Splitting the Surgical Global: Modifiers 54 and 55 When Surgeon and Follow-Up Differ

When your orthopedic surgeon operates but a different physician or group takes over the post-op care, you do not bill two full surgeries. You split one global package between two claims.

Short answer

The operating surgeon reports the surgical CPT with modifier 54 (surgical care only). The provider assuming follow-up reports the same CPT, same date of service, with modifier 55 (postoperative management only). Medicare pays each party its share of the global package, prorated by the post-op days each one actually owns. A written transfer of care is required in both charts.

Surgical care only. Billed by the operating surgeon.

Postoperative management only. Billed by the follow-up provider.

Preoperative management only. Used when yet a third party does the pre-op work.

90 / 10 / 0

Post-op day windows CMS assigns to each surgical code (major, minor, endoscopy).

The split, end to end

One 90-day global, two entities, two claims

A total knee (CPT 27447) carries a 90-day global. If the surgeon relinquishes care at discharge and a different orthopedic group runs the follow-up, the global is divided at the transfer point. Both claims carry the identical procedure code and the identical surgery date.

Intra-op share

Entity A

Operating Surgeon

CPT + Modifier 54

Performs the procedure
Owns pre-op and the surgery itself
Bills the surgical code with 54
Paid the intra-op (and pre-op) portion

Written
Transfer of Care

➤

Post-op share

Entity B

Follow-Up Provider

CPT + Modifier 55

Assumes care after discharge
Same CPT, same surgery date
Reports date care was assumed + days covered
Paid the post-op portion, prorated by days

Surgeon = modifier 54 Follow-up = modifier 55 Same CPT · same DOS on both

How the 90-day global gets carved up

CMS Medicare Physician Fee Schedule Relative Value Files assign every global code a pre-op, intra-op, and post-op percentage. Modifier 55 pays the post-op slice, divided by the days each provider covers.

Day 0Surgery

Days 1–20Surgeon (54)

Days 21–90Follow-up provider (55)

Day 0Day 30Day 60Day 90

Modifier 55 payment mechanic (illustrative)

Mod 55 pay = full fee × post-op % (from the MPFS RVU file) × ( days you cover ÷ total post-op days in the global )

Example: on a 90-day code, a group covering days 21–90 owns 70 of 90 post-op days, so it earns 70/90 of the post-op portion. The surgeon's modifier 54 claim keeps the intra-op and pre-op shares plus the days it retained. Percentages are code-specific; always pull the live RVU file, never a fixed assumption.

Reference

Which modifier, who bills it, what it pays

Modifier	Meaning	Who reports it	What it pays
54	Surgical care only	Operating surgeon who did the procedure	Pre-op + intra-op portion of the global (plus any post-op days retained before transfer)
55	Postoperative management only	Physician or group that assumes follow-up	Post-op portion, prorated by the days covered
56	Preoperative management only	Provider handling only the pre-op workup	Pre-op portion (rarely billed separately; used in three-way splits)

Modifier 54 and 55 attach to the surgical CPT, not to an office visit code. Post-op E/M visits inside the global are still bundled for whoever owns that stretch of the window. Only surgery codes with a 10-day or 90-day global can be split this way; a 000-day (XXX) code has no post-op period to transfer.

✓Do this on every split

Document a written transfer of care; keep a copy in both the surgeon's and the follow-up provider's records.
Report the identical surgical CPT and the identical date of surgery on both claims.
On the modifier 55 claim, record the date care was assumed and the number of post-op days covered.
Pull the code-specific post-op percentage from the current MPFS Relative Value File.
Confirm the code carries a 10- or 90-day global before splitting.

!Costly mistakes to avoid

Billing a full global on both sides. That is a duplicate and a refund risk.
Using modifier 55 with no written transfer, or a transfer dated after the follow-up visits started.
Billing separate post-op E/M visits inside a window you already relinquished.
Splitting a 000-day (XXX) global code that has no post-op period.
Assuming a flat post-op percentage instead of the code's actual RVU split.

Guidelines this page follows

CMS Global Surgery Booklet (MLN Booklet)Defines the global surgical package and the split-care rules for modifiers 54, 55, and 56.
Medicare Claims Processing Manual, Chapter 12, Section 40Governs surgeries with split global periods, transfer-of-care documentation, and the days-covered reporting on modifier 55.
CMS CY2026 Physician Fee Schedule Final RuleSets the current conversion factor and payment amounts that flow through each prorated global share.
MPFS Relative Value Files (post-operative percentages)Carry the pre-op, intra-op, and post-op percentage split and the 000 / 010 / 090 global indicator for every surgical code.

Split-global claims are where orthopedic revenue quietly leaks

Missed modifier 55 proration, transfers with no paper trail, and duplicate globals cost orthopedic groups real money and invite refund demands. ASP-RCM's orthopedic billing services build the transfer-of-care workflow and the modifier logic into your claim edits so every split global is coded, dated, and paid correctly the first time.

Talk to our orthopedic billing team ➤