BWC Policy Communication and Notice

BWC implemented bill payment processing changes on Aug. 1, 2010. These changes impact services having an effective date on or after Aug. 1, 2010 and include the following:

• Modifier #54 (surgical care only) appended to all emergency department procedures for professional services;

• 90-day global period for major surgeries reduced to 60 days.

The change with Modifier #54 addresses the misapplication of global surgical billing, which has resulted in unnecessary administrative costs by BWC to correct payments made to the wrong provider. It also addresses delayed reimbursement to the correct provider who provided the follow-up care. The 60-day global period for major surgeries change refines the current global surgery follow-up period. This improvement recognizes the role primary care providers, or physicians of record play in facilitating a prompt, safe recovery and return to work for an injured worker who has experienced major surgery. Shortening the follow-up period will facilitate earlier engagement by the primary care providers or physician of record. The next Billing and Reimbursement Manual and MCO Policy Reference Guide will reflect these policy changes or revisions.