Medicare AdvantageAdministrativeMedium impact
MA03.008c, Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
Independence Blue Cross·Orthopedics, General Surgery, Cardiothoracic Surgery +8 more·Coding
Effective date
Mar 5, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage has reissued policy MA03.008c regarding Modifier 78 for unplanned returns to the operating room by the same physician during the postoperative period. This is a reissue of existing guidance with no apparent changes to the underlying billing requirements.
Action Required
By March 5, 2025: Billing team should review the reissued MA03.008c policy to ensure current billing practices for Modifier 78 align with Medicare Advantage requirements for unplanned returns to OR during postoperative periods. Verify billing software and staff training are consistent with the policy guidance.