CORRECT USAGE OF MODIFIER 59

Due to recent provider inquiries regarding incorrect denials of CPT codes billed with modifier 59, Cahaba ran a report to identify all claims denied as duplicates with the use of modifier 59. The report is being researched and adjustments will be made to incorrectly denied claims using an automated system. Until the claims have all been adjusted, our Clerical Error Reopening lines will not adjust claims denied as a duplicate appended with modifier 59 to avoid creating overpayments. When all adjustments are completed, an update will be placed on the claims issues log at MCS Claims Processing System Issues  and you may again call the Clerical Error Reopening lines to adjust any outlying claims. Cahaba also asks that you do not submit any written redeterminations or Clerical Error Adjustments until you are notified that all adjustments are completed. Thank you for your patience. The current claims processing guidelines for the proper use of modifier 59 is based on an article published on our “What’s New” webpage at https://www.cahabagba.com/news/correct-usage-of-modifier-59/