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59 Modifiers

On August 1st, WebPT removed the 59 modifiers from the old CMS PTP edits for the mutually exclusive code pairs 97140 and 97530. The problem I am experiencing is that when our sessions are automatically transfered over to Therabill, I am having to manually add the 59 modifier for all claims, with the two pair codes, for all of my private payers. Even 6 months after CMS edited the pair codes as not needing a 59 modifier, private insurance is still denying the two codes as "mutually exclusive" without the 59 modifier. I have asked Therabill for a workaround, but no alternative suggestion is realistic. I am hoping, with enough interest, WebPT can revert back to adding the 59 modifiers.

  • Guest
  • Aug 4 2021
  • Unlikely to Implement
  • Aug 5, 2021

    Admin response

    We have been working to monitor these denials and are actively evaluating if we do need to add these modifiers back in. We ran some testing by manually removing the 59 modifiers on some of our payers that were previously denying the claims and had seen initial success with those payers paying for the codes appropriately. There is an option to use the additional modifiers in the EMR for specific payers rather then adding them in manually in Therabill.

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  • Guest commented
    15 Nov, 2021 03:35pm

    Need to use the XU modifier for these codes if used together.

  • Guest commented
    5 Aug, 2021 05:09pm

    That is weird because I have gotten EDI rejections without the 59 modifier for UHC. For BCBS and Aetna, I get a partial payment just for line item 97140 but they deny and adjust to $0 for the CPT code missing the modifier.

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