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 to the same Medicare beneficiary during the same treatment session. 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; however, CMS has not yet mandated their use. The new subsets of modifier 59 along with the definition of each are as follows:
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