New Subsets of Modifier 59

November 2, 2015
Rick Gawenda

Modifier 59 is used in the outpatient therapy setting to identify when one intervention was provided at a separate and distinct time from another intervention by one discipline to the same Medicare beneficiary during the same treatment session or same date of service when multiple disciplines treat the Medicare patient within the same organization (non-private practice setting or incident-to-physician). Modifier 59 is not only the most commonly used modifier, but is also the most abused modifier that is utilized. Due to this, the Centers for Medicare and Medicaid Services (CMS) has defined four new HCPCS modifiers to selectively identify subsets of Distinct Procedural Services (-59 modifier). The effective date of the new subsets of modifier 59 was January 1, 2015 and providers can use them for their Medicare patient’s; however, CMS has not yet mandated their use. Over the next 4 weeks beginning on November 10th, I will provide examples of when to use each of the 4 new subsets of modifier 59. The new subsets of modifier 59 along with the definition of each are as follows:

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