Wiki PT and OMT, Modifier 59

[jackiekrichter]

. When both services are provided in the same encounter, PT Re-eval 97164 and OMT 98925, which CPT code should get modifier 59? (The provider is a Physical Therapist)

 

[OpenClaims]

You would bill the charge with the higher revenue first. So whatever your allowable is for one unit (if you are billing multiple units). Whichever code/unit has the higher RVU would go on the claim first and then the second code would follow with the 59 modifier. I would first check your PTP edits/NCCI edits and see if these 2 codes can be billed together and if a modifier is allowed.

 

[jackiekrichter]

You would bill the charge with the higher revenue first. So whatever your allowable is for one unit (if you are billing multiple units). Whichever code/unit has the higher RVU would go on the claim first and then the second code would follow with the 59 modifier. I would first check your PTP edits/NCCI edits and see if these 2 codes can be billed together and if a modifier is allowed.

Thank you so much, this was very helpful!