Billing modifier · CMS claims manual

Modifier 55: the follow-up care, without the surgery.

Modifier 55 reports postoperative management only: a physician other than the surgeon takes over follow-up care during the global period by agreement. The receiving physician cannot bill any part of the global services until providing at least one service, then bills from the date care was assumed.

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

Modifier 55 at a glance

Modifier: 55: Postoperative Management Only
Used on: Physician who provides postoperative management only
Medicare rule: Cannot bill until at least one service is provided; bills from the date care was assumed
Primary source: CMS Ch. 12 s.40.2.A.3

What CMS says

CMS chapter 12, section 40.2.A.3 pairs modifier 54 (surgical care only) with 55 (postoperative management only). Both bills carry the same date of service and surgical procedure code. The date care was assumed must be shown on the claim, and the written transfer agreement kept in the medical record.

Where a transfer of postoperative care occurs, the receiving physician cannot bill for any part of the global services until he or she has provided at least one service. Once the patient has been seen, that physician may bill for the period beginning with the date on which care was assumed.

Special cases

If the transfer occurs immediately after surgery, the physician other than the surgeon who provides in-hospital postoperative care bills subsequent hospital care codes for the inpatient care and the surgical code with modifier 55 for the post-discharge care. The surgeon bills the surgery code with 54.

A physician who is responsible for postoperative care and has reported and been paid with modifier 55 uses modifier 24 to report any unrelated visits.

HPSA example from CMS: if the postoperative portion is provided in a Health Professional Shortage Area, it is billed with 55 and the HPSA modifier, and the 10 percent bonus is paid on that postoperative portion only.

Limits

A specialist treating an underlying condition or complication during the global period, such as a cardiologist managing cardiovascular disease, bills an evaluation and management code with no modifier. Modifier 55 is for the transferred postoperative care itself.

Look-alike modifiers

Modifier 54: The surgeon’s side of the transfer.
Modifier 58: Staged or related procedure.
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 55.

Sources

CMS: Medicare Claims Processing Manual, Chapter 12 (Rev. 13753, issued 05-07-26) — sections 40.2 and 40.2.D, billing requirements and HPSA payments (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

When can the physician using modifier 55 start billing?

Only after providing at least one service. Billing then runs from the date care was assumed, per CMS.

What does an unrelated visit by the 55 physician use?

Modifier 24, per CMS chapter 12, for unrelated visits during the postoperative period.

Does a cardiologist managing an underlying condition use modifier 55?

No. CMS says that physician reports the appropriate evaluation and management code and no modifier is necessary.

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.