Author Topic: modifier 59  (Read 2148 times)


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modifier 59
« on: May 08, 2008, 10:49:47 AM »
I recently got a claim rejected that had two procedure codes on it, with the second procedure code having modifier 59, for separate, distinct service.  When I called to appeal, to Horizon BCBS, they told me that as of 1-1-08, they no longer recognize modifier 59.  When asked what modifier I should use to show two separate procedures, their response was they couldn't tell me!  Has anyone else heard of this??  I know you have to back up the use of the modifier, which I was prepared to do with the office notes, but not allowing it at all???


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Re: modifier 59
« Reply #1 on: May 08, 2008, 01:41:25 PM »
   No I haven't heard of this.  It seems very strange.  I don't know how they could not recognize the 59 modifier.  I would contact your BC provider rep for your area and question them.  It just doesn't seem ok to not recognize a modifier that there is really no other modifier that does the same thing.

Let us know what you find out.  I'm curious.

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Re: modifier 59
« Reply #2 on: June 10, 2008, 06:50:04 PM »
I Bill for an ASC in Oregon, and Blue Cross of Oregon will only pay on the primary CPT code and no others, no matter what modifier I use. I don't know who your are billing for, but Modifier 59 does not work when billing B/C for an ASC


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Re: modifier 59
« Reply #3 on: July 20, 2008, 09:16:50 PM »

I work for my local BCBS and we recognize the -59 modifier, maybe the person you contacted didn't really understand what you were asking/inquiring about.  That has happened to me many times we I have spoken to our Provider Representatives over the phone.