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Wiki PT and OMT, Modifier 59

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jackiekrichter

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. When both services are provided in the same encounter, PT Re-eval 97164 and OMT 98925, which CPT code should get modifier 59? (The provider is a Physical Therapist)
 
You would bill the charge with the higher revenue first. So whatever your allowable is for one unit (if you are billing multiple units). Whichever code/unit has the higher RVU would go on the claim first and then the second code would follow with the 59 modifier. I would first check your PTP edits/NCCI edits and see if these 2 codes can be billed together and if a modifier is allowed.
 
OpenClaims said:
You would bill the charge with the higher revenue first. So whatever your allowable is for one unit (if you are billing multiple units). Whichever code/unit has the higher RVU would go on the claim first and then the second code would follow with the 59 modifier. I would first check your PTP edits/NCCI edits and see if these 2 codes can be billed together and if a modifier is allowed.
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Thank you so much, this was very helpful! :)
 
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