Wiki ambulatory surgical centers and 59 modifier

[marionroberta]

Are there any rules or guidelines regarding an ambulatory surgical center filing with a 59 modifier? I am lookiong for specific guidelines as to whether a facility should be eligible for additional reimbursement if the 59 modifier is used compared to when a physician files with the modifier. thanks

 

[nsteinhauser]

Not sure what you're asking. If you look in the 'Appendix A' in the back of the CPT book, you can page back to 'Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use' and -59 is one of them.

As far as how it's different from using it in billing other non-E/M fees (for professional physician/surgeon charges), the definition is the same for -59 under the ASC section in the CPT book and under the general section of the CPT book. So you use it in the same way.

But even if it's in that appendix, each payer makes their own rules. I have payers that won't let me use -59 modiifers. So you want to check if you're not sure.

Hope this helps.