Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. Usage to identify a separate encounter is infrequent and usually correct; usage to define a separate anatomic site is less common and problematic; usage to define a distinct service is common and

Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. Usage to identify a separate encounter is infrequent and usually correct; usage to define a separate anatomic site is less common and problematic; usage to define a distinct service is common and

The Centers for Medicare and Medicaid Services (CMS) implemented the Multiple Procedure Payment Reduction (MPPR) policy in 2011 to outpatient therapy services provided to Medicare beneficiaries seen by one or more disciplines on the same day by the same private practice or non-private practice setting (i.e. same group NPI number or Tax ID number). I am often asked how the MPPR is applied and to what CPT codes does the MPPR apply to. I will answer those 2 questions below and provide you with a reference document from CMS detailing which CPT codes the MPPR does apply to when billed