Modifier -59 Reimbursement Win for Podiatrists

January 9, 2018

patient services provided form, check, pen

APMA has been advocating to CMS for the revision of recently issued National Correct Coding Initiative (NCCI) guidance, as it relates to the -59 modifier and coding for CPT 11055 and 11720. APMA has been in correspondence with CMS since 2016, and most recently met directly with CMS in August 2017, to address this problem, providing materials and background information to CMS representatives.

In a partial win for members, CMS issued a new MedLearns Matters Article (MLN Matters®Number: SE1418) on January 3, with updated examples that directly addressed the use of the -59 modifier and CPT 11055 and 11720. “Proximal to the DIPJ” corn(s) on a toe will now be covered when paired. While CMS still does not cover a distal corn with no relationship to the nail, APMA will continue to fight for this justified reimbursement, and we are hopeful for a positive result.

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