Advanced Search

Medicare Compliance & Reimbursement

Modifiers:

Modifier 57 Still Applies to Some Part B Claims, Despite Consult Pay Elimination

Published on Sat May 21, 2011

Don't ignore modifier 57 just because CMS stopped reimbursing for consults. Medicare may have stopped paying for consult codes in 2010, but that doesn't mean modifier 57 no longer serves a purpose. Follow these quick tips to find out how this modifier can still serve your practice's needs. Background: Starting Jan. 1, 2010, CMS eliminated consult codes (99241-99245, 99251-99255) from the Medicare Physician Fee Schedule. Although these codes are still listed in CPT®, Part B MACs will no longer pay you if you report them. Non-Consult E/M Codes Keep Modifier 57 Alive Modifier 57 (Decision for surgery) was often considered the go-to code for procedures performed on the same date as consults. So when CMS stopped paying for consults, you might have wondered if modifier 57 would remain useful. The answer? You can still use this modifier with a non-consult E/M code that leads to the decision to perform surgery, [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Medicare Compliance & Reimbursement

View All