Medicare: Changing the Way You Use Modifier 59

For those of you who use Modifier 59 when submitting claims to the Centers for Medicare and Medicaid Services, the way in which it is used will be changing for dates of service on and after July 1, 2019. This is particularly important in cases where two seemingly similar services are provided on the same date of service.


Click here to read our Part 1 of our series about how to participate in MIPS reporting.


A recent article from Gawenda Seminars and Consulting provided an example using CPT code 97012 (mechanical traction) and CPT code 97140 (manual therapy). Previously, if these two treatments were performed on the same date of service, the 59 modifier would need to be appended to 97140 on the claim form. Failure to do so would result in you only being reimbursed for one of those services.


The reason for this was that mechanical traction was seen as a component of the manual therapy. But things are about to get a lot simpler.


Read more about MIPS in 2019 for PTs in Part 2 of our series on MIPS.


In keeping with our example, beginning July 1, 2019, providers will be able to append the 59 modifier on either of the two CPT codes. Whether it’s 97012 or 97140, by appending the 59 modifier, you will ensure that you receive reimbursement for both services.


The CMS has published a more comprehensive explanation of the changes to Modifier 59, EX, XP, XS, and XU and you can check it out here.


And if you found this article helpful, we recommend heading to the Gawenda Seminars and Consulting website and learning more about their offerings.

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