Physical Therapy and 59 modifiers


True Blue
Midvale, UT
Best answers
Any help would be appreciated per Medicare guidelines when we are billing a 97110 and 97150 together we need to add a 59 modifier to both lines. This makes no sense to me when those are the only 2 codes we are billing. See Medicare guidelines below.

Medicare Guidelines
6. Group and Individual CPT Codes Billed on Same Day:

Billing for both individual (one-on-one) and group services provided to the same patient in the same day: This is allowed, provided the CPT and CMS rules for one-on-one and group therapy are both met. However, the group therapy session must be clearly distinct or independent from other services and billed using a -59 modifier. The group therapy CPT code (97150) and the direct one-on-one 15-minute CPT Codes for therapeutic procedures (97110 - 97542) are subject to Medicare's National Correct Coding Initiative (NCCI). The NCCI edits require the group therapy and the one-on-one therapy to occur in different sessions, time frames, or separate encounters that are distinct or independent from each other when billed on the same day. The therapist would use the -59 modifier to bill for both group therapy and individual therapy CPT codes to distinguish that the two coded services represent different sessions or separate encounters on the same day. Without the -59 modifier, payment would be made for the lower-priced group therapy CPT Code, in accordance with CPT/CCI rules. The CCI edits are based upon interpretation of coding rules.