In which situation can a provider use Modifier 55?

Modifier 55 is appropriately used when a provider offers follow-up care after surgery. This modifier signifies that the surgeon is not responsible for the entire surgical procedure, including the preoperative and postoperative management; instead, they are only involved in the postoperative follow-up care that occurs after another provider performed the surgical procedure.

After a surgery, a patient may require ongoing management, and if a different provider or physician is responsible for this aspect of care, Modifier 55 indicates that the provider is billing for the continuing care that follows the surgical procedure. This includes any assessments, monitoring, or interventions necessary after the patient has undergone a surgical operation.

Other scenarios presented do not align with the proper use of Modifier 55. Using Modifier 55 for preoperative assessments is not appropriate, as it is strictly for postoperative care. Similarly, modifier 55 would not apply in cases where a procedure fails at its onset or when a patient decides not to have surgery, as these situations do not involve the ongoing management after surgery. Thus, follow-up care is the only valid context for the application of Modifier 55.