Modifier 59 Use in Outpatient Therapy

December 12, 2014
Rick Gawenda

I receive many questions on the use of modifier 59 for outpatient therapy services. A few common questions I receive are “What is the definition of modifier 59?, When can I use modifier 59?” and my favorite “I have been told by my billing people that I can only use modifier 59 if I see the patient for 2 visits on the same day, not during a single visit, is that true?” I am going to answer the above 3 questions plus provide you with a document from the Centers for Medicare and Medicaid Services (CMS) that will support my answers and you can share with those back in your practice and organization.

The definition of modifier 59 is as follows:

The content here is for members only log in here or sign up.

All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.

This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  1. Hello Rick,
    I attended the 11/24/14 webinar titled: “2015 Therapy Payment Updates: New/Revised CPT Codes & Medicare Therapy Cap”. In that webinar, you stated that CMS has informed the APTA and ASHA that outpatient therapy services would (as of the date of the webinar at least) be exempt from using the modifier 59 subsets. Is that still true? Can you point me to a document from either organization that verifies so I can share with our billing and coding department? Thank you, Scott.

    1. You would have to go to the APTA or ASHA website and search for the information. Not sure if it is a member benefit page or available to non-members.

  2. I realize that I will be able to use certain of the new modifiers (especially when the CPT codes are from different clinician) but will the use of 59 put me under the Medicare microscope if I use it?

    1. The new subset modifiers are not going into effect for outpatient therapy services on January 1, 2015. Information about modifier 59 is available on the Current News page of my website.

  3. Thank you for your article on -59 modifiers & I just reviewed your CCI-edit list and have one question. The top said most commonly used codes and our list coincides with your list except for one combination of CPT codes–does 97112 need a -59 modifier when used with 97110? That was the only other one we were using after checking our list against yours.

    1. 97110 and 97112 can be provided on the same day to a Medicare beneficiary and no modifier 59 is required on either CPT code.