What does CPT modifier 58 mean?

Guidelines and Instructions. Submit CPT modifier 58 to indicate that the performance of a procedure or service during the postoperative period was either: Planned prospectively at the time of the original procedure (staged); More extensive than the original procedure; or. For the therapy following a surgical procedure.

Why do we use 58 modifier?

Modifier 58 is used for a “staged or related procedure or service by the same physician during the post-operative period.” Further, according to CMS.gov, modifier 58 indicates that the procedure was: Planned, either at the time of the first procedure or prospectively.

How does modifier 58 affect reimbursement?

Modifier 58: to indicate a second procedure was performed as a staged procedure. Reimbursement should be 100% of the allowable fee. Modifier 79: To indicate an unrelated procedure was performed during the global period of the original procedure. Reimbursement should be 100% of the allowable fee.

When should modifier 59 be used?

Modifier 59 is used appropriately for different anatomic sites during the same encounter only when procedures which are not ordinarily performed or encountered on the same day are performed on different organs, or different anatomic regions, or in limited situations on different, non-contiguous lesions in different …

Does 96372 need a modifier?

When you need to bill an office visit and an injection on the same day, you have two options. The cpt 96372 is for an intramuscular injection of a J-code. You can bill the office visit and the substance all day and they will all get paid separately with no modifiers.

What is the modifier for bilateral procedure?

Modifier -50 is used for bilateral procedures that are performed at the same operative session. When reporting modifier -50 to indicate a bilateral procedure, report the procedure on one claim line.

Does CPT 97597 need a modifier?

There are no bilateral T or F modifiers required. Furthermore, if you only bill these two codes together, there is no need to append any modifiers such as a 59 modifier to CPT 97598 when billing with CPT 97597. When it comes to both CPT 97597 and CPT 97598, you should bill these at their full allowed value.

What is 96365 CPT code?

The Current Procedural Terminology (CPT) code 96365 as maintained by American Medical Association, is a medical procedural code under the range-Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration). Search across CPT® codesets.