Guidelines for Using Modifier 59 vs. XS

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Did you know there are requirements related to modifier 59 when utilizing the CPT codes 97124 (therapeutic massage) and 97140 (manual therapy), or 97112 (neuromuscular re-education)?

According to the Correct Coding Initiative Edits, physical medicine and rehabilitation services described by CPT codes 97112, 97124, and 97140 are not separately reportable when performed in a spinal region undergoing chiropractic manipulative treatment (CMT).

“When these physical medicine and rehabilitation services are performed in a different region than CMT, and the provider is eligible to report physical medicine and rehabilitation codes, the provider may report CMT and the above codes using modifier 59 or XS.”

The use of modifier 59 or XS indicates the service is a separate and distinct service from manipulation; however, the use of modifier XS would technically be more correct or accurate than 59.

Make sure you are only using 59 or XS for massage and manual therapy; and only on the same visit as a CMT service.

Billing with incorrect chiropractic CPT codes can lead to claim rejections and delays in payments, which can have a devastating impact on generating revenue and keeping you in business. 

If you are experiencing insurance claim denial, staff spending too much time trying to get claims paid, and patients asking why their claims have not been paid then H. J. Ross Company is your solution.

H.J Ross Company stays ahead of the curve on the latest trends and changes in billing and coding by utilizing their direct channel of communication with the insurance companies and organizations that set the guidelines.

There is a reason chiropractors have trusted H.J. Ross Company with their business for over 40 years.