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59,51

  1. Default 59,51
    Clearnace Sale
    We are having a dispute about what modifier comes first, the 59 or the 51?

  2. #2
    Location
    Columbia, MO
    Posts
    13,027
    Default
    Ok here is how I teach it to my students:
    In short language 59 says "pay me because I am a different procedure"
    51 says "reduce me because I was done in the same session"
    you always want the modifier first that affect your reimburse ment the most in your favor, so "pay me" before "reduce me".

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Daytona Beach, FL
    Posts
    752
    Default
    I just listened to a Webinar on Modifiers by our local Medicare and the way they implied it, was that the 51 modifier was not needed with the 59. They say that the system would add the 51 modifier if needed. You might want to check with the carrier to see if they require a 51 or if they will automatically apply this. Just a thought.

    Jodi Dibble, CPC

  4. #4
    Location
    Columbia, MO
    Posts
    13,027
    Default
    It is true that many carriers now no longer want the 51 and have deleted it out of the electronic edits, so what that means is the presence of the 51 can cause a claim to deny as it is not recognized. So yes check with the carrier first.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    East Valley, Tempe AZ
    Posts
    44
    Default
    We have found Blue Cross / Blue Shield is the only carrier that still requires modifier 51.

  6. Default
    In my state, Massachusetts, Medicaid (Masshealth) does not even recognize the 59 modifier. So we always have to use the 51, which they recognize.

  7. Default
    thank you very much I appreciate it

  8. #8
    Default Masshealth and Mod 59, 51
    Quote Originally Posted by CathyO View Post
    In my state, Massachusetts, Medicaid (Masshealth) does not even recognize the 59 modifier. So we always have to use the 51, which they recognize.
    Can you give an example. I am new to biling MassHealth.

    Ty

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