Can someone tell me how medicare reimburse the surgeon for a surgery code billed with modifier 78?---patient is within the Global period. The First procedure was performed inpatient and the second procedure was at ASC. I am finding that the second proceure will be paid at 70% of the fee schedule, but not sure if that is correct. Thank you
Check with your Medicare carrier. The following information is specific to WPS Medicare.
Modifier 78 reimbursement is intra-operative percentage only.
Use Modifier 78 to document treatment of complications only.
Use Modifier 78 to indicate services furnished in an operating room (OR). OR definition, for this purpose, is a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, laser suite, or endoscopy suite. It does not include a patient's room, minor treatment room, recovery room, or intensive care unit.
Does not apply to assistant at surgery services
Does not apply to Ambulatory Surgical Centers facility fees