Wiki Modifier 59

[Prada]

What is the actual percentage reduction when Modifier 59 is used?

 

[Orthocoderpgu]

Modifier -59 does not reduce the payment...

 

[Prada]

Modifier -59 does not reduce the payment...

Thank you for the response.
I often see it mentioned that mod 59 only means that its a separately billable service and not bundled but does involve multiple procedure reduction for same day services.
Is there any CMS or other reference that you might know?

 

[Orthocoderpgu]

The basic idea is that the second procedure is paid at about 50% and then the rest get paid at 25%.

 

[csperoni]

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

provides all the details - start on page 84 for 40.6 Claims for Multiple Surgeries.
The general idea is that not all multiple surgeries are supposed to be billed -59. Modifier -59 is often overused and should be utilized only when appropriate. https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/modifier59.pdf
Modifier -59 does not override the multiple surgery payment reduction and is "used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances."