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Reimbursement Issues Related to Modifier 58

Topic: Modifier 58

Sponsor: Corcoran Consulting Group

Updated: 01/01/2022

Corcoran Consulting Group

CPT defines modifier 58 as, “Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period”.  Furthermore, “It may be necessary to indicate that the performance of a procedure or service during the postoperative period was:  (a) planned or anticipated (staged); … (b) more extensive than the original procedure;  or (c) for therapy following a surgical procedure.”

This FAQ addresses the following:

  1. What is modifier 58?
  2. How is modifier 58 different from modifier 78?
  3. What is the effect of these modifiers on payment?

It also includes eight examples.