Surgical Modifiers

Surgical Modifiers A. The applicable modifiers for bilateral procedures, multiple procedures, co-surgeons, surgical teams, and assistant surgeons must be utilized on claims for surgery. B. Medicaid reimburses for surgical care only at eighty-five percent (85%) of the Medicaid allowable. The applicable modifier for this service must be reported with the appropriate surgery procedure codes. C. Medicaid reimburses for postoperative management only at fifteen percent (15%) of the Medicaid allowable. The applicable modifier for this service must be reported with the appropriate surgery procedure codes. 1. Medicaid requires a documented agreement for the transfer of care when one (1) physician performs a patient’s surgical service and another provides the postoperative management. 2. The agreement must be in the form of a letter, discharge summary, chart notation, or other written documentation and be retained in each physician’ beneficiary’s medical record. D. No separate benefits are allowed for preoperative management as it is inclusive in the allowance for surgical care.