Advocacy & Practice Updates — Advocacy & Practice
New for 2025: Expanded Requirements for Transfer of Care Modifier -54
Over the past several years, CMS has tried to reduce any duplication or overpayments in the post-surgical period and enhance transparency particularly for codes with 90-day global periods.
For 2025, whenever a surgeon plans or expects to only provide the surgical portion of a global package, they will need to document modifier -54, whether the transfer is informal or formal, and within the same group TIN.
Appending this modifier will reduce the payment rate to reflect that the surgeon is not providing the postoperative portion of the service. If the postoperative service is performed by another practitioner in the same TIN, the global code should be billed with the -55 modifier to receive full payment.
For the physician providing the post-op care, CMS implemented a new add-on code HCPCS G0559. This code should be used when the physician providing post-op care didn’t have the benefit of a formal transfer of care, particularly when the physician may not have been involved in creating the surgical plan and may not have access to the operative notes. This add-on code should not be used by another practitioner in the same group practice or specialty as the person who performed the procedure. Documentation should justify use of the code which should only be used one time during the 90-day global period.
Be on the lookout for more specific guidance from your Medicare Administrative Contractor.
(Published January 14, 2025)