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Q/A: For Physical Therapy Claims, What is the Correct Modifier Order?

By:  Wyn Staheli, Director of Research
Published:  May 27th, 2019

Question

Page 116 of the 2019 ChiroCode Deskbook shows examples for Medicare modifiers. Is this the specific order for the modifiers to be entered? Our practice management software system is advising the GP or GY should be used as Modifier 1 and not as Mod 2 or Mod 3.

Also, it shows the 59 Modifier listed as 1st. Doesn't Medicare require the use of the X modifier and not 59? Should the XS modifier be used in place of 59?

Answer

The modifiers showing in the DeskBook are not in any particular order because that order can vary depending on the payer. Technically speaking, payment modifiers (e.g., 22, TC) come before informational modifiers (e.g., GP), but the payer's policy is the determining factor as to the order of the modifiers. Some, but not all, payers automatically reorder modifiers when a claim is submitted. Many billing experts agree that the order of these particular modifiers DOES NOT MATTER.

As for modifier XS, some payers want to see the X{ESPU} instead of modifier 59 (if applicable). However, this again goes back to the specific requirements of the payer. We do recommend using the appropriate X{ESPU} instead of the 59, but if you have a claim rejected, you'll need to use modifier 59 when you resubmit the claim.


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