Wiki Modifier 59 Denials

[sweetpea0715]

We have started getting denials from BCBS and Humana Medicare on any CPT codes that have a modifier 59. BCBS is indicating that the modifier is invalid, but when we remove the modifier they deny the services as bundled with another procedure. Humana Medicare is bundling any code that that has a modifier 59. Does anyone know how to get around this or have any suggestions? Thanks

 

[mitchellde]

Try using one of the X modifiers instead of the 59, XE, XS, XP, or XU whichever one would apply to your scenario

 

[ellzeycoding]

It also depends on what you are billing. Modifier 59 or X modifiers may not even be appropriate at all.

Humana and Humana Medicare Advantage recognize both modifier 59 and X modifier

Attached is their tip sheet

They also have a modifier 59 (X modifier) training presentation

https://www.humana.com/provider/support/tools/making-it-easier