Fusion will add a Modifier 59 to a billing code on a claim when:
- The therapist indicated the services were provided distinctly on a daily note.
- The codes in the "Requires 59 Modifier" column will receive Modifier 59.
Fusion will also mark a claim as a problem if a code in the "Cannot be billed" column is on the same claim as a code in the "CPT Code" column for that row.
NOTE: A biller can still edit the modifiers on a claim to manually add or remove them. You should always review our claims for accuracy before submitting them.
TIP! To best find the CPT code you are looking for, use the Find option. From Windows, click Ctrl+F and enter our desired code in the search box. From a Mac, click Command+F.
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The following information has been supplied by Gawenda Seminars & Consulting and is from their Private Practice Version 28.2 listing. For the most up-to-date version of the following information, please visit Gawenda Seminars & Consulting. Gawenda Seminars & Consulting are leaders in education and consulting in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services for Physical Therapy, Occupational Therapy, and Speech Therapy. They provide consulting, webinars, and seminars to private practices pertaining to physical, occupational, and speech-language pathology therapy services. To learn more about Gawenda Seminars & Consulting and review membership options, please visit gawendaseminars.com. We thank Gawenda Seminars & Consulting for allowing us to share this with you. |
|
CPT Code |
Descriptor |
Requires 59 Modifier |
Cannot be billed |
|
90912 |
Biofeedback Pelvic Health: Initial 15 Minutes |
97032; 97110; 97112; 97530; 97535; 97750 |
90901 |
|
90913 |
Biofeedback Pelvic Health: Each Additional 15 |
97032; 97110; 97112; 97530; 97535; 97750 |
90901 |
|
G0451 |
Developmental testing |
96125; 96146; 96160; 96161 |
96523; 96127 |
|
92507 |
Treatment of Speech & Language, Individual |
97110; 97112; 97150; 97530; 97533 |
0373T; 36591; 36592; 69209; 69210; 96523; G0268; 97155; 97156; 97157; 97153; 97154; |
|
92508 |
Speech Group |
0373T; 97110; 97112; 97150; 97530; 97533 |
36591; 36592; 69209; 69210; 92507 ; 96523; 97154; 97155; 97156; 97157; 97158; G0268n |
|
92521 |
Evaluation of Speech Fluency |
96105; 96125; 96130; 96132; 96136; 96138; 96146 |
36591; 36592; 69209; 69210; 92620; 92621; 96523; 97151; 97152; G0268 |
|
92522 |
Evaluation of Speech Production |
96105; 96125; 96130; 96132; 96136; 96138; 96146 |
36591; 36592; 69209; 69210; 92620; 92621; 96523; 97151; 97152; G0268 |
|
92523 |
Evaluation of Speech Production with Evaluation of Language Comprehension and Expression |
96105; 96125; 96130; 96132; 96136; 96138; 96146; |
36591; 36592; 69209; 69210; 92522; 92620; 92621;96523; 97151; 97152; G0268 |
|
92524 |
Behavioral and Qualitative Analysis of Voice & Resonance |
96105; 96125; 96130; 96132; 96136; 96138; 96146 |
36591; 36592; 69209; 69210; 92620; 92621; 96523; 97151; 97152; G0268 |
|
92526 |
Treatment of Swallowing Dysfunction |
69705; 69706; 92511; 92520; 96523; 97032; 97110; 97112; 97150; 97530 |
36591; 36592; 97802; 97803; 97804; G0270; G0271; G0283; |
|
92597 |
Evaluation of Voice Prosthetic |
|
36591; 36592; 96523; 97755 |
|
92607 |
Evaluation of Speech Generating Device; First Hour |
92507; 92508; 92521; 92522; 92523; 92524; 92609 |
36591; 36592;96523; 97755; 92597 |
|
92608 |
Eval of Speech Device (each additional 1/2 hour) |
|
36591; 36592; 96523; 97755 |
|
92609 |
Programming and Training for Speech Generating Device |
92507; 92508; 92521; 92522; 92523; 92524 |
36591; 36592; 96523; 97755 |
|
92610 |
Evaluation of Swallowing |
92511 |
35691; 35692; 96523 |
|
92611 |
Modified Swallow Study |
69705; 69706; 70370; 92511; 92610 |
36591; 36592; 70371; 76120; 76125; 96523 |
|
92612 |
Flexible Endoscopic Eval of Swallowing |
92610; 92611 |
31575; 36591; 36592; 69705; 69706; 76120; 76125; 92511; 92520; 92614; 96523 |
|
92614 |
Flexible Endoscopic Evaluation; Laryngeal Sensor Testing by Cine or Video Recording |
92610; 92611 |
31575; 36591; 36592; 69705; 69706; 76120; 76125; 92511; 92520; 96523 |
|
92616 |
Flexible Endoscopic Evaluation of Swallowing and Laryngeal Sensor Testing by Cine or Video Recording |
92610; 92611 |
31575; 36591; 36592; 69705; 69706; 76120; 76125; 92511; 92520; 92612; 92614; 96523 |
|
95992 |
Canalith Re-positioning |
97110; 97112; 97140; 97530 |
36591; 36592; 92531; 92532; 96523; |
|
96105 |
Assessment of Aphasia |
96110; 96125; 96160; 96161; G0451 |
36591; 36592;96127; 96146; 96523; 97151; 97152; 97153; 97154; 97155; 97156; 97157; 97158; |
|
96110 |
Developmental Testing, Limited |
96125 |
36591; 36592;;96146; 96523; 97151; 97152; 97153; 97154; 97155; 97156; 97157; 97158 |
|
96112 |
Developmental Test Administration; First Hour |
90791; 90792; 90832; 90833; 90834; 90836; 90837; 90838; 90839; 90845; 90846; 90847; 90849; 90853; 90865; 90870; 90880; 92002; 92004; 92012; 92014; 96105; 96125; 96130; 96131; 96160; 96161; 97161; 97162; 97163; 97164; 97165; 97166; 97167; 97168; G0380; G0381; G0382; G0383; G0384; G0410; G0411; G0463; Check E&M Codes as well (99201 - 99497) |
0362T; 0373T; 36591; 36592;96127;96110;96132; 96133; 96136; 96137; 96138; 96146;96523; 97151; 97152; 97153; 97154; 97155; 97156; 97157; 97158;G0451; |
|
96113 |
Developmental Test Administration; Each Additional 30 Minutes |
90791; 90792; 90832; 90833; 90834; 90836; 90837; 90838; 90839; 90845; 90846; 90847; 90849; 90853; 90865; 90870; 90880; 92002; 92004; 92012; 92014; 96125; 96127; 96146; 96160; 96161; 97161; 97162; 97163; 97164; 97165; 97166; 97167; 97168; G0380; G0381; G0382; G0383; G0384; G0410; G0411; G0463; Check E&M Codes as well (99201 - 99497) |
0362T; 0373T; 36591; 36592;96110;96523; 97151; 97152; 97153; 97154; 97155; 97156; 97157; 97158;G0451 |
|
96125 |
Standardized Cognitive Performance Testing |
96160; 96161 |
36591; 36592; 96127; 96146;96523; 97151; 97152; 97153; 97154; 97155; 97156; 97157; 97158 |
|
29581 |
Multi-Layer Compression System - Below Knee |
29540; 29550; 29580; 64454; 97140; 97535 |
64451 |
|
29584 |
Multi-Layer Compression System - Entire Arm |
29125; 29126; 29130; 29131; 29260; 64454; 97140; 97535 |
64451 |
|
97012 |
Mechanical Traction |
97018; 97140; 97164; 97168 |
96523 |
|
G0281 |
Electrical Stimulation - Stage 3-4 Wounds |
97032; 97164; 97168; G0283 |
96523 |
|
G0283 |
Electrical Stimulation - Other Than Wound Care |
64451; 64454; 97032; 97164; 97168 |
96523 |
|
97016 |
Vasopneumatic Device |
97018; 97026; 97164; 97168 |
96523 |
|
97018 |
Paraffin Bath |
97022; 97164; 97168 |
96523 |
|
97022 |
Whirlpool |
97602; 97164; 97168 |
96523 |
|
97024 |
Diatherm |
97018; 97026; 97164; 97168 |
96523 |
|
97026 |
Infrared |
97018; 97022; 97164; 97168 |
96523 |
|
97028 |
Ultraviolet |
97018; 97022; 97026; 97164; 97168 |
96523; |
|
97032 |
Electrical Stimulation, Manual |
97164; 97168 |
96523 |
|
97033 |
Iontophoresis |
97164; 97168 |
96523 |
|
97034 |
Contrast Bath |
97164; 97168 |
96523 |
|
97035 |
Ultrasound |
97164; 97168 |
96523 |
|
97036 |
Hubbard Tank |
97164; 97168 |
96523 |
|
97039 |
Unlisted Modality |
97164; 97168 |
96523 |
|
97110 |
Therapeutic Exercises |
|
36591; 36592; 96523 |
|
97112 |
Neuromuscular Re Education |
97022; 97036 |
36591; 36592; 96523 |
|
97113 |
Aquatic Therapy/Exercises |
97022; 97036; 97110 |
36591; 36592; 96523 |
|
97116 |
Gait Training |
|
36591; 36592; 96523 |
|
97124 |
Massage |
97164; 97168 |
96523 |
|
97129 |
Cognitive Function - Initial 15 Minutes |
97155; 97164; 97168 |
36591; 36592; 96523; 97153 |
|
97130 |
Cognitive Function - Each Additional 15 Minutes |
97164; 97168 |
36591; 36592; 96523; 97153; 97155 |
|
97139 |
Physical Medicine Procedure |
97164; 97168 |
36591; 36592; 96523 |
|
97140 |
Manual Therapy |
95851; 95852; 97018; 97750 |
36591; 36592;96523;97124; |
|
97150 |
Group Therapeutic Procedures |
97110; 97112; 97113; 97116; 97124; 97140; 97530; 97533; 97535; 97537; 97542; 97760; 97761; 97763 |
36591; 36592; 95851; 96523;97153; 97154; 97155; 97156; 97157; 97158 |
|
97151 |
Behavior Identification Assessment |
96160; 96161 |
0403T; 0488T; 36591; 36592; 90867; 90868; 90869; 90882; 90889; 96523 |
|
97152 |
Behavior Identification - Supporting Assessment |
0403T; 0488T; 96160; 96161; |
36591; 36592; 90867; 90868; 90869; 90889;96523 |
|
97153 |
Adaptive Behavior Treatment by Protocol |
0403T; 0488T |
36591; 36592; 90867; 90868; 90869; 90882; 90889; 92508; 96523 |
|
97154 |
Group Adaptive Behavior Treatment by Protocol |
0403T; 0488T |
36591; 36592; 90867; 90868; 90869; 90882; 90889; 96523 |
|
97155 |
Adaptive Behavior Treatment by Protocol Modification |
0403T; 0488T |
36591; 36592; 90867; 90868; 90869; 90882; 90889; 96523 |
|
97156 |
Family Adaptive Behavior Treatment Guidance |
0403T; 0488T |
36591; 36592; 90867; 90868; 90869; 90882; 90889; 96523 |
|
97157 |
Multiple-Family Group Adaptive Behavior Treatment Guidance |
0403T; 0488T |
36591; 36592; 90867; 90868; 90869; 90882; 90889; 96523 |
|
97158 |
Group Adaptive Behavior Treatment by Protocol Modification |
0403T; 0488T; 90863 |
36591; 36592; 90785; 90791; 90792; 90832; 90833; 90834; 90836; 90837; 90838; 90839; 90840; 90845; 90846; 90847; 90849; 90853;90865; 90867; 90868; 90869; 90870; 90875; 90876; 90880; 90882; 90885; 90887; 90889; 92507; 96523 |
|
97161 |
Physical Therapy Eval - Low Complexity |
96105; 96125; 96130; 96132; 96136; 96138; 96146 |
36591; 36592; 95851; 95852;96156; 96158; 96159; 96164; 96165; 96167; 96168; 96523; 97164; 97750; 97755; 97763 |
|
97162 |
Physical Therapy Eval - Moderate Complexity |
96105; 96125; 96130; 96132; 96136; 96138; 96146 |
36591; 36592; 95851; 95852;96156; 96158; 96159; 96164; 96165; 96167; 96168; 96523; 97161; 97164; 97750; 97755; 97763 |
|
97163 |
Physical Therapy Eval - High Complexity |
96105; 96125; 96130; 96132; 96136; 96138; 96146 |
36591; 36592; 95851; 95852;96156; 96158; 96159; 96164; 96165; 96167; 96168; 96523; 97161; 97162; 97164; 97750; 97755; 97763 |
|
97164 |
Physical Therapy Re-evaluation |
96105; 96125; 96130; 96132; 96136; 96138; 96146 |
36591; 36592; 95851; 95852;96156; 96158; 96159; 96164; 96165; 96167; 96168; 96523; 97750; 97755; 97763 |
|
97165 |
Occuaptional Therapy Eval - Low Complexity |
96105; 96125; 96130; 96132; 96136; 96138; 96146 |
36591; 36592; 95851; 95852;96156; 96158; 96159; 96164; 96165; 96167; 96168; 96523; 97151; 97152; 97168; 97750; 97755; 97763 |
|
97166 |
Occupational Therapy Eval - Moderate Complexity |
96105; 96125; 96130; 96132; 96136; 96138; 96146 |
36591; 36592; 95851; 95852n 96156; 96158; 96159; 96164; 96165; 96167; 96168; 96523; 97151; 97152; 97165; 97168; 97750; 97755; 97763 |
|
97167 |
Occupational Therapy Eval - High Complexity |
96105; 96125; 96130; 96132; 96136; 96138; 96146 |
36591; 36592; 95851; 95852;96156; 96158; 96159; 96164; 96165; 96167; 96168; 96523; 97151; 97152; 97165; 97166; 97168; 97750; 97755; 97763 |
|
97168 |
Occuptional Therapy Re-evaluation |
96105; 96125; 96130; 96132; 96136; 96138; 96146 |
36591; 36592; 95851; 95852;96156; 96158; 96159; 96164; 96165; 96167; 96168; 96523; 97151; 97152; 97750; 97755; 97763 |
|
97530 |
Therapeutic Activities |
97537; 97542; 97750 |
36591; 36592; 95851; 95852; 96523; 97153; 97154; 97155; 97156; 97157; 97158 |
|
97533 |
Sensory Integration |
97164; 97168 |
36591; 36592; 96523; 97153; 97154; 97155; 97156; 97157; 97158 |
|
97535 |
Self Care/Home Management Training |
97164; 97168 |
36591; 36592; 96523; G0270; G0271 |
|
97537 |
Community /Work Reintegration |
97164; 97168 |
36591; 36592; 96523; G0270 |
|
97542 |
Wheelchair Management - Assessment and Training |
97164; 97168 |
36591; 36592; 96523 |
|
97545 |
Work Hardening; First 2 Hours |
97164; 97168 |
36591; 36592; 96523; 97140 |
|
97597 |
Wound Care Selective First 20 sq centimeters |
29105; 29125; 29126; 29130; 29131; 29200; 29240; 29260; 29280; 29305; 29325; 29345; 29355; 29358; 29365; 29405; 29425; 29435; 29440; 29445; 29450; 29505; 29515; 29520; 29530; 29540; 29550; 29580; 29581; 29584; 97022; 97164; 97605; 97606; 97607; 97608; (Check Other E&M Codes) |
96523; 97602 |
|
97598 |
Wound Care Selective; Each additional 20 sq centimeters or any part thereof |
29105; 29125; 29126; 29130; 29131; 29200; 29240; 29260; 29280; 29305; 29325; 29345; 29355; 29358; 29365; 29405; 29425; 29435; 29440; 29445; 29450; 29505; 29515; 29520; 29530; 29540; 29550; 29580; 29581; 29584; 97022; 97164; 97605; 97606; 97607; 97608; 97610, (Check Other E&M Codes) |
96523; 97602 |
|
97602 |
Wound Care Non-Selective |
29105; 29125; 29126; 29130; 29131; 29200; 29240; 29260; 29280; 29305; 29325; 29345; 29355; 29358; 29365; 29405; 29425; 29435; 29440; 29445; 29450; 29505; 29515; 29520; 29530; 29540; 29550; 29580; 29581; 29584; 97164 |
96523; 97607; 97608 |
|
97605 |
Negative Pressure Wound Therapy < or = to 50sq cm using Durable Medical Equipment |
97164; 97607; 97610 |
36591; 36592; 96523; 97602; 97608 |
|
97606 |
Negative Pressure Wound Therap Greater than 50sq cm using Durable Medical Equipment |
97164; 97608; 97610 |
36591; 36592; 96523;97602; 97605; 97607 |
|
97607 |
Negative Pressure Wound Therapy < or = to 50sq cm using non-Durable Medical Equipment |
97164 |
36591; 36592; 96523 |
|
97608 |
Negative Pressure Wound Therapy Greater than 50sq cm using non-Durable Medical Equipment |
97164 |
36591; 36592; 96523; 97607 |
|
97610 |
Low Frequency , Non-Contact, Non-Thermal Ultrasound |
97035; 97607; 97608 |
36591; 36592; 96523; 97602 |
|
97750 |
Physical Performance Test or Measurement |
|
36591; 36592; 95851; 95852; 96523; 97150 |
|
97755 |
Assistive Technology Assessment |
97035; 97110; 97112; 97140; 97530; 97533; 97535; 97537; 97542; 97545; 97761; 97763 |
36591; 36592; 95851; 95852; 96523; 97150; 97750 |
|
97760 |
Orthotic Management & Training, Initial Orthotic(s) Encounter |
0213T; 0216T; 0228T; 0229T; 0230T; 0231T; 29044; 29046; 29049; 29055; 29058; 29065; 29075; 29085; 29105; 29125; 29126; 29130; 29131; 29200; 29240; 29260; 29280; 29305; 29325; 29345; 29355; 29358; 29365; 29405; 29425; 29435; 29440; 29445; 29450; 29505; 29515; 29520; 29530; 29540; 29550; 29580; 29581; 29584; 97016; 97110; 97112; 97116; 97124; 97140; 97164; 97168 |
36591; 36592; 96523; 97763 |
|
97761 |
Prosthetic Management & Training, Initial Prosthetic(s) Encounter |
97016; 97110; 97112; 97116; 97124; 97140; 97164; 97168; 97760; |
36591; 36592; 96523; 97763 |
|
97763 |
Orthotic/Prosthetic Management and/or Training, Subsequent Orthotic/Prosthetic Encounter(s) |
0213T; 0216T; 0228T; 0229T; 0230T; 0231T; 29044; 29046; 29049; 29055; 29058; 29065; 29075; 29085; 29105; 29125; 29126; 29130; 29131; 29200; 29240; 29260; 29280; 29305; 29325; 29345; 29355; 29358; 29365; 29405; 29425; 29435; 29440; 29445; 29450; 29505; 29515; 29520; 29530; 29540; 29550; 29580; 29581; 29584; 97016; 97110; 97112; 97116; 97124; 97140 |
36591; 36592; 96523 |
|
98975 |
Remote Therapeutic Monitoring - Initial Set-Up and Patient Education |
|
36591; 36592; 93241; 93242; 93243; 93244; 93245; 93246; 93247; 93248; 96523; 99091; 99473 |
|
98976 |
Remote Therapeutic Monitoring - Respiratory System |
|
36591; 36592; 93241; 93242; 93243; 93244; 93245; 93246; 93247; 93248; 96523; 99091; 99473 |
|
98977 |
Remote Therapeutic Monitoring - Musculoskeletal System |
|
36591; 36592; 93241; 93242; 93243; 93244; 93245; 93246; 93247; 93248; 96523; 99091; 99473 |
|
98978 |
RemoteTherapeuticMonitoring-CognitiveBehavioralTherapy |
96158;96159 |
36591;36592;96523;98975;98976; 98977;99091;99424;99425;99426;99427;99437; 99439;99453;99454;99457;99458;99484;99492; 99493;99494 |
|
98980 |
Remote Therapeutic Monitoring Treatment Management Services - Initial 20 Minutes |
|
97750 |
|
98981 |
Remote Therapeutic Monitoring Treatment Management Services - Each Additional 20 Minutes |
|
97750 |
|
99453 |
Remote Monitoring of Physiologic Parameters, Initial; Set-Up and Patient Education on Use of Equipment |
98975; 98976; 98977; 0733T |
|
|
99454 |
Remote Monitoring of Physiologic Parameters, Initial; Device(s) Supply with Daily Recording(s) or Programmed Alert(s) Transmission, each 30 |
98975; 98976; 98977; 0733T |
|
|
99457 |
Remote Physiological Monitoring Treatment Management Services - Initial 20 Minutes |
99091; 0734T |
97750; 98980 |
|
99458 |
Remote Physiological Monitoring Treatment Management Services - Each Additional 20 Minutes |
|
97750; 98980; 99091 |