Medicare AdvantageBilling CodesHigh impact
MA03.017c, Modifiers for Shared or Split Surgical Services (Modifiers 54, 55, 56)
Independence Blue Cross·General Surgery, Cardiothoracic Surgery, Neurosurgery +5 more·Medical Policy
Effective date
Apr 16, 2025
We identified it
Jun 19, 2026
Summary
This policy reissue (effective 04/16/2025) addresses the proper use of modifiers 54, 55, and 56 for shared or split surgical services under Medicare Advantage plans. The billing team must ensure correct modifier application when multiple surgeons participate in a single procedure to avoid claim denials and ensure accurate reimbursement.
Action Required
By 04/16/2025: Billing team must review and update all surgical billing protocols to ensure correct application of modifiers 54 (surgical care only), 55 (postoperative management only), and 56 (preoperative management only) for shared surgical cases. Update billing software rules and encounter templates to flag multi-surgeon procedures requiring modifier assignment. Providers must document which phase of care each surgeon is responsible for (pre-op, intra-op, post-op). Train all surgical billing staff on modifier requirements. Failure to apply correct modifiers will result in claim denials and payment delays from Medicare Advantage plans.