NatRevMD

#131 Modifier 59 Explained: Correct Uses, Wrong Uses, and How to Avoid Costly Denials


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Free Resource:
Make sure eligibility isn’t causing preventable denials. Download the free Eligibility Checklist → https://natrevmd.com/eligibility-billing-verification/

Modifier 59 is one of the most overused—and misunderstood—modifiers in medical billing. In this episode, Dr. Heather Signorelli breaks down exactly when 59 is appropriate, when it isn’t, and why using it on labs (like a UA) is a major compliance mistake.

You’ll learn:

  • The real CPT and Medicare definition of modifier 59
  • When to use 59 vs the X-modifiers
  • Why adding 59 rarely changes payment but can flip denials
  • The most common misuse patterns
  • Clinical examples from urgent care, ortho, GI, and OB/GYN
  • How to document a truly “distinct procedural service”

Need a billing partner who understands this?
Learn more at NatRevMD.com. 

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