CPT modifier
Modifier 59: Distinct procedural service
Modifier 59 is a CPT modifier. In plain terms: A procedure or service that is separate from another one done the same day, for example a different site, a different session or a separate injury, so an NCCI edit should not bundle it.
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- Modifier
- 59
- Type
- CPT (Level I) modifier, maintained by the AMA
- Plain description
- A procedure or service that is separate from another one done the same day, for example a different site, a different session or a separate injury, so an NCCI edit should not bundle it.
- How it is used
- Use only when no more specific modifier fits. CMS created XE, XP, XS and XU as more exact choices. The record must show why the services were distinct.
- Claim form
- CMS-1500 item 24D, up to four modifiers per line. 837P SV101-3 to SV101-6.
The CPT descriptor is AMA copyright and is not shown here. The description above is written by Rivvi. Read the CMS guidance linked above for Medicare's rules.
Distinct and repeat services
- XESeparate encounter, a service that is distinct because it occurred during a separate encounter
- XPSeparate practitioner, a service that is distinct because it was performed by a different practitioner
- XSSeparate structure, a service that is distinct because it was performed on a separate organ/structure
- XUUnusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
- 76Repeat procedure by the same physician
- 77Repeat procedure by another physician
- 91Repeat clinical diagnostic lab test
Multiple procedures and modifiers
Related modifiers
- XESeparate encounter, a service that is distinct because it occurred during a separate encounter
- XPSeparate practitioner, a service that is distinct because it was performed by a different practitioner
- XSSeparate structure, a service that is distinct because it was performed on a separate organ/structure
- XUUnusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
- 76Repeat procedure by the same physician
- 77Repeat procedure by another physician
- 91Repeat clinical diagnostic lab test
- 51Multiple procedures
- 99Multiple modifiers
- 50Bilateral procedure
Related pages
- All CPT and HCPCS modifiersA to Z list
- CMS-1500 claim formModifiers go in item 24D
- Denial code CO-4Modifier missing or does not fit the code
- Denial code CO-182Modifier invalid on the date of service
- Denial code CO-97Included in another service
- Denial code CO-236Procedure or modifier pair not compatible
- HCPCS Level II code lookup
- Denial and remark codes
Questions
What does modifier 59 mean?
Modifier 59 is a CPT modifier. In plain terms: A procedure or service that is separate from another one done the same day, for example a different site, a different session or a separate injury, so an NCCI edit should not bundle it.
Is modifier 59 a CPT or a HCPCS modifier?
59 is a CPT (Level I) modifier. The AMA maintains CPT modifiers. Two-character codes with a letter, such as GT or XU, are HCPCS Level II modifiers from CMS.
Where does modifier 59 go on a claim?
On the CMS-1500 it goes in item 24D next to the procedure code. Each line holds up to four modifiers. On an 837P it goes in SV101-3 to SV101-6.
When is modifier 59 used?
Use only when no more specific modifier fits. CMS created XE, XP, XS and XU as more exact choices. The record must show why the services were distinct.
What denial comes back when a modifier is wrong?
A missing or mismatched modifier often comes back as CARC 4. A modifier that was not valid on the date of service comes back as CARC 182. A bundling edit the modifier should have bypassed comes back as CARC 97 or 236.