Critical Care Services Provided During Preoperative and post operative

Preoperative critical care and/or postoperative care may be paid in addition to a global fee if the patient is critically ill and requires the full attention of the physician, and the critical care is unrelated to the specific anatomic injury or general surgical procedure performed. Such patients may meet the definition of being critically ill and criteria for conditions where there is a high probability of imminent or life threatening deterioration in the patient’s condition.

• For preoperative care modifier -25 (significant, separately identifiable evaluation and management services by the same physician on the day of the procedure) must be used with the HCPCS code

• For postoperative care modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period) must be used with the HCPCS code.

In addition, for each preoperative and postoperative care the diagnosis must clearly indicate that the critical care was unrelated to the surgery.

Ventilator Management


Medicare recognizes the ventilator codes (CPT codes 94002 – 94004, 94660 and 94662) as physician services payable under the physician fee schedule. Medicare Part B under the physician fee schedule does not pay for ventilator management services in addition to an evaluation and management service (e.g., critical care services, CPT codes 99291 – 99292) on the same day for the patient even when the evaluation and management service is billed with CPT modifier -25.