Billing modifier · CMS claims manual

Modifier 54: the surgery, without the postoperative care.

Modifier 54 reports surgical care only: the surgeon performed the procedure but another physician, by agreement, provides the postoperative management. The matching modifier for the receiving physician is 55. Both claims carry the same date of service and the same surgical code.

Sources: CMS manuals · retrieved November 2, 2026Reference page · nothing is sent or stored

Modifier 54 at a glance

Modifier: 54: Surgical Care Only
Used on: Surgeon who provides surgical care only after a transfer of care
Medicare rule: Same date and code as the modifier 55 claim; transfer date in remarks
Primary source: CMS Ch. 12 s.40.2.A.3

What CMS says

CMS chapter 12, section 40.2.A.3: where physicians agree on the transfer of care during the global period, “-54” is used for surgical care only and “-55” for postoperative management only. The two bills contain the same date of service and the same surgical procedure code, distinguished by the modifier.

The claim does not have to say that care was transferred, but the date care was relinquished or assumed must be shown in the remarks field or free text segment. The surgeon and the receiving physician must each keep a copy of the written transfer agreement in the beneficiary’s medical record.

Dates and localities

A surgeon who relinquishes care at discharge need only show the date of surgery. If the surgeon also cared for the patient for a period after discharge, the surgeon shows the date of surgery and the date care was relinquished (Item 19 on the paper CMS-1500).

If the surgery is in one payment locality and the postoperative care in another, the surgery is billed with modifier 54 to the A/B MAC serving the locality where it was performed. The sums paid in two localities will not equal the global amount because of geographic adjustments.

Limits

Occasional post-discharge services by a physician other than the surgeon, with no transfer of care, are reported with an evaluation and management code and no modifier. Physicians in the same group practice that bills the global package under reassigned benefits bill the whole package. Private payers may follow the same split or not; confirm with the payer.

Look-alike modifiers

Modifier 55: The receiving physician’s postoperative management.
Modifier 58: Staged or related procedure in the global period.
Modifier 57: Decision for surgery visit.

The full modifier descriptions are in the AMA CPT code book and the HCPCS Level II code set; this page covers only what the CMS claims manuals say about modifier 54.

Sources

CMS: Medicare Claims Processing Manual, Chapter 12 (Rev. 13753, issued 05-07-26) — sections 40.1 and 40.2, global surgery definition and billing requirements (retrieved 2026-11-02)

Every rule above was read from these CMS pages on November 2, 2026. Payers revise policies and contracts, so confirm anything that affects a claim with the payer or your Medicare Administrative Contractor.

Frequently asked questions

Who uses modifier 54?

The surgeon who performs the operation when, by agreement, another physician provides the postoperative care. That physician uses modifier 55.

Must the claim show that care was transferred?

Not in words, but CMS says the date care was relinquished or assumed must appear in the remarks field or free text segment, and a written transfer agreement must be kept in the medical record.

Do modifier 54 and 55 claims use different procedure codes?

No. CMS says both bills contain the same date of service and the same surgical procedure code.

Not legal, billing or medical advice

This page explains published CMS manual text. It cannot see your claim, your contract or any payer’s policy. Confirm with the payer or your Medicare Administrative Contractor (MAC) before you bill, resubmit or appeal.