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Modifier 59

CPT numeric modifiers (AMA · CPT Appendix A)

Modifier 59. Distinct Procedural Service — non-E/M service distinct from another same-day service (different site/session/lesion). Heavy OIG target; use only when no more specific X modifier fits.

This is a high-denial-risk modifier and a known OIG audit target — append it only when the documentation supports a distinct or separately identifiable service.

Reference only — CPT descriptors are AMA-copyrighted (paraphrased). Payment percentages and acceptance vary by payer; verify against the current CPT/HCPCS files and payer policy.

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Unrelated E/M During a Postoperative Period — same physician provides an E/M unr…
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Significant, Separately Identifiable E/M on the Same Day as a Procedure — E/M ab…
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Professional Component — bills only the physician's interpretation/supervision p…
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Multiple Outpatient Hospital E/M Encounters on the Same Date — facility (hospita…
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Mandated Services — service required by a third party (e.g., a payer-mandated se…
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