tci Medicare Compliance & Reimbursement - 2011 Issue 12

Modifiers: Modifier 57 Still Applies to Some Part B Claims, Despite Consult Pay Elimination

Don't ignore modifier 57 just because CMS stopped reimbursing for consults. Medicare may have stopped paying for consult codes in 2010, but that doesn't mean modifier 57 no longer serves a purpose. Follow these quick tips to find out how this modifier can still serve your practice's needs.Background: Starting Jan. 1, 2010, CMS eliminated consult codes (99241-99245, 99251-99255) from the Medicare Physician Fee Schedule. Although these codes are still listed in CPT®, Part B MACs will no longer pay you if you report them. Non-Consult E/M Codes Keep Modifier 57 Alive Modifier 57 (Decision for surgery) was often...

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