Centers for Medicare & Medicaid Services (CMS) Current Procedural Terminology (CPT) 59 Modifier Changes
All MHP providers are affected by this modifier change.
The CPT modifier 59 is used to identify procedures/services, other than evaluation/management services, that are not normally reported together, but that are appropriate under the circumstances. Because it can be applied broadly, some providers incorrectly assume this modifier can be used to bypass the National Correct Coding Initiative (NCCI).
The NCCI has procedure-to-procedure edits to prevent unbundling and consequent overpayment to physicians and outpatient facilities. The underlying principle is that the second code defines a subset of the work of the first code so it would be inappropriate to report it separately. Separate reporting triggers a separate payment and would constitute as double billing.
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