MAY 07, 2024
Can We Bill the Patient When the Payer Does Not Recognize Co-management?
We perform co-managed post-operative care for cataract surgery and billed a payer that did not recognize the shared care modifiers. It paid the surgeon but not the claim appended with modifier -55. Can we bill the patient?
Answer:
Not all payers recognize co-management arrangements and billing. If a payer does not recognize modifiers -54 and -55, you are not able to bill co-management for enrollees with that plan. Patients with such plans should be followed by the surgeon for all post-operative care.
Follow these 5 Co-Management Coding Tips when considering co-management.