Modifier 56 (Preoperative Management Only) is used when one physician provides only the preoperative care for a surgical procedure, while another physician performs the surgery and/or postoperative management. It is one of the three modifiers used to divide the global surgical package, along with Modifier 54 (Surgical Care Only) and Modifier 55 (Postoperative Management Only).

Although Modifier 56 is used less frequently than Modifiers 54 and 55, it remains important in situations where patient care is shared among multiple physicians. This may occur when a primary care physician, specialist, or referring physician performs the preoperative evaluation and preparation, while a different surgeon performs the operation.

Medical billers, coders, and AR callers should understand when Modifier 56 is appropriate, how Medicare handles split global care, and what documentation is required to support reimbursement.

Modifier Number

Modifier Name

Preoperative Management Only

Note: The official CPT® descriptor is maintained by the American Medical Association (AMA). Always refer to the latest licensed CPT® codebook for the official wording.

Plain English Explanation

Modifier 56 tells the payer:

“I provided only the preoperative management for this surgery. Another physician performed the operation and/or postoperative care.”

The provider reporting Modifier 56 is billing only for the medically necessary services performed before the surgical procedure as part of the global surgical package.

Purpose of Modifier 56

Modifier 56 is used to:

Report preoperative management only.
Identify shared global surgical care.
Prevent duplicate billing.
Support reimbursement when global care is divided among physicians.
Comply with Medicare and payer-specific global surgery policies.

Understanding the Global Surgical Package

The global surgical package generally includes:

Preoperative care related to the surgery.
The surgical procedure.
Routine postoperative care during the global period.

When one physician performs all services, the surgical CPT® code is billed without Modifiers 54, 55, or 56.

When different physicians share responsibility, the modifiers are divided as follows:

Modifier	Responsibility
54	Surgical Care Only
55	Postoperative Management Only
56	Preoperative Management Only

When to Use Modifier 56

Modifier 56 is appropriate when:

One physician performs only the preoperative management.
Another physician performs the surgery.
The transfer of care is documented when required.
The procedure has a global surgical period.
The payer recognizes split global surgical billing.

Common Examples

✔ A primary care physician completes the preoperative evaluation and surgical preparation before referring the patient to an orthopedic surgeon.

✔ A cardiologist performs the required preoperative cardiac evaluation and surgical clearance before cardiac surgery performed by another surgeon.

✔ A specialist evaluates and prepares the patient for surgery, while the operation is completed at a tertiary care center by a different physician.

✔ A referring physician manages preoperative optimization before transferring the patient to a surgical specialist.

When NOT to Use Modifier 56

Do not use Modifier 56 when:

The same physician performs the preoperative care, surgery, and postoperative management.
The service is unrelated to the planned surgery.
Billing a separately reportable Evaluation and Management (E/M) service that is not part of the global package.
The procedure has no global surgical period.
Documentation does not support preoperative management responsibilities.

Medicare Rules

Medicare permits Modifier 56 only in limited situations involving the transfer of global surgical care.

Important Medicare considerations include:

Modifier 56 is appended to the surgical CPT® code.
Documentation must support that only preoperative management was provided.
The physician performing the surgery generally reports Modifier 54 when postoperative care is transferred.
The physician providing postoperative care reports Modifier 55 when appropriate.
Not all Medicare Administrative Contractors (MACs) process Modifier 56 in the same way, so local guidance should always be reviewed.

Always verify current CMS and MAC billing instructions before claim submission.

Commercial Insurance Rules

Commercial insurance policies vary significantly.

Some payers:

Recognize Modifier 56.
Require written transfer-of-care documentation.
Require communication between providers.
May not reimburse separately for preoperative management.
Have payer-specific global surgery policies.

Always review the payer’s provider manual before billing.

Documentation Requirements

Documentation should include:

Complete preoperative evaluation.
Medical necessity for surgery.
Surgical risk assessment.
Diagnostic findings.
Treatment plan.
Referral to the operating surgeon.
Date care was transferred.
Communication between physicians.
Physician signature.

Clear documentation supports medical necessity and establishes responsibility for the preoperative portion of care.

Real Billing Examples

Example 1 – Orthopedic Surgery

A primary care physician performs a comprehensive preoperative assessment for a patient scheduled for total hip replacement.

The patient is then referred to an orthopedic surgeon who performs the surgery and provides postoperative care.

The primary care physician may report the surgical CPT® code with Modifier 56 if payer policy allows split global billing.

Example 2 – Cardiac Surgery

A cardiologist evaluates a patient, optimizes cardiac medications, completes preoperative testing, and prepares the patient for coronary artery bypass surgery.

The cardiovascular surgeon performs the operation.

Modifier 56 may be appropriate if payer requirements are met.

Example 3 – Incorrect Use

An orthopedic surgeon evaluates the patient before surgery, performs the operation, and provides all postoperative care.

Modifier 56 should not be reported because the surgeon provided the complete global surgical package.

CMS-1500 Claim Example

Field	Example
CPT Code	Surgical CPT® code
Modifier	56
Diagnosis Pointer	Appropriate ICD-10-CM diagnosis
Units	1
Charges	Provider’s billed amount

Common Denial Reasons

No documentation supporting preoperative management.
Physician also performed the surgery.
Missing transfer-of-care documentation.
Procedure has no global period.
Payer does not recognize Modifier 56.
Duplicate billing.

How to Correct the Denial

Review the Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA).
Confirm the physician provided only preoperative management.
Verify payer recognition of Modifier 56.
Submit preoperative documentation.
Include referral and transfer-of-care records.
Appeal with supporting medical records if appropriate.

Coding Tips

Use Modifier 56 only when the physician provides preoperative management alone.
Verify that the procedure has an applicable global period.
Maintain detailed preoperative documentation.
Confirm payer acceptance of Modifier 56 before billing.
Review Medicare Administrative Contractor (MAC) guidance for local requirements.

Modifier 56 vs Modifier 54 vs Modifier 55

Modifier	Description
54	Surgical Care Only
55	Postoperative Management Only
56	Preoperative Management Only

These modifiers divide the global surgical package among multiple physicians when patient care is shared.

Frequently Asked Questions (FAQs)

Q1. Who reports Modifier 56?

Answer: The physician who provides only the preoperative management before surgery, while another physician performs the operation.

Q2. Can the operating surgeon also report Modifier 56?

Answer: Generally, no. Modifier 56 is intended for physicians who provide only the preoperative portion of the global surgical package.

Q3. Is Modifier 56 commonly used?

Answer: No. Modifier 56 is used less frequently than Modifiers 54 and 55 because, in many cases, the operating surgeon also performs the preoperative management.

Q4. Does every payer recognize Modifier 56?

Answer: No. Some commercial insurers and Medicare contractors may have different billing requirements or may not reimburse separately for preoperative management. Always verify payer policy.

AR Caller Tips

When following up on a denied Modifier 56 claim:

Confirm that the payer recognizes Modifier 56.
Verify the surgery had a global period.
Ensure transfer-of-care documentation is available.
Submit the complete preoperative evaluation if requested.
Record the payer representative’s name, call reference number, and follow-up instructions.

Interview Questions

Question 1

What is Modifier 56 used for?

Answer: Modifier 56 reports preoperative management only when another physician performs the surgery and/or postoperative care.

Question 2

How does Modifier 56 relate to Modifiers 54 and 55?

Answer: Together, these modifiers divide the global surgical package among physicians responsible for the preoperative, surgical, and postoperative portions of care.

Question 3

Why is documentation important?

Answer: Documentation demonstrates that the physician performed only preoperative management and supports reimbursement for the services provided.

Practice Scenario

Scenario

A patient is referred to a tertiary medical center for complex spinal surgery. Before referral, the patient’s local physician performs the complete preoperative assessment, orders laboratory tests, optimizes chronic medical conditions, and prepares the patient for surgery. The neurosurgeon at the tertiary center performs the operation and manages postoperative care.

Question

Should Modifier 56 be considered?

Answer

Yes. If payer policy allows split global billing and documentation clearly supports that the local physician provided only preoperative management, Modifier 56 may be appropriate.

Related Modifiers

Modifier 54 – Surgical Care Only.
Modifier 55 – Postoperative Management Only.
Modifier 57 – Decision for Surgery.
Modifier 58 – Staged or Related Procedure During the Postoperative Period.
Modifier 78 – Unplanned Return to the Operating Room.
Modifier 79 – Unrelated Procedure During the Postoperative Period.

Common Billing Mistakes

Billing Modifier 56 when the physician also performed the surgery.
Failing to document preoperative management.
Billing unrelated E/M services with Modifier 56.
Ignoring payer-specific global surgery rules.
Using Modifier 56 for procedures without a global period.

Key Takeaways

Modifier 56 reports preoperative management only.
It is used when another physician performs the surgery and/or postoperative care.
It is part of Medicare’s split global surgery modifiers with Modifiers 54 and 55.
Thorough documentation and transfer-of-care records are essential.
Always verify Medicare and commercial payer policies before billing.

References

CMS Medicare Claims Processing Manual.
CMS Global Surgery Booklet.
Medicare Administrative Contractor (MAC) billing guidance.
National Correct Coding Initiative (NCCI) Policy Manual.
Licensed AMA CPT® codebook for official modifier descriptors.

Conclusion

Modifier 56 is an important, though less commonly used, modifier that supports accurate reporting of preoperative management only within the global surgical package. When patient care is shared among multiple physicians, correct use of Modifier 56—along with Modifiers 54 and 55—ensures compliant billing, prevents duplicate payments, and promotes accurate reimbursement. Success with Modifier 56 depends on detailed documentation, proper transfer-of-care records, and adherence to CMS and payer-specific billing guidelines.

Educational Disclaimer

This article was prepared with the assistance of artificial intelligence (AI) for educational and informational purposes. It is based on publicly available CMS guidance, Medicare billing resources, and general medical billing practices. It is not an official publication of the American Medical Association (AMA), CMS, or any insurance payer. CPT® is a registered trademark of the American Medical Association. Always consult the latest AMA CPT® codebook, CMS manuals, Medicare Administrative Contractor (MAC) guidance, National Correct Coding Initiative (NCCI) policies, and payer-specific billing policies before coding, billing, or submitting claims.