If the patient's primary insurance is Medicare and a “55” modifier is entered, this attachment will be triggered.

| Prompt | Response | Req | Len |
|---|---|---|---|
| Date of Relinquished Care | Enter the date you want or click the calendar icon to select a date. | 10 | |
| Date of Assumed Care | Enter the date you want or click the calendar icon to select a date. | 10 |