Help with Modifier 59 or 51??

donnakrysl@adapt.us

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St. Louis West
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I am trying to bill MO HealthNet (and Medicare) for multiple procedures with E/M:

99214-25
99406 smoking cx Modifier 59 (or 51?)
90471 vac admin (G0009-Medicare)
90732 Pneumonia vaccine

Is the modifier put on the 1st procedure billed? Does it matter which procedure?
 
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