Modifier 59 Fact Sheet
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DDE Navigation & Password Reset: (866) 580-5986
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DDE System Access: (866) 518-3295
8:00 am to 5:30 pm ET M-F
EDI: (866) 234-7331
8:00 am to 5:00 pm ET M-F
General Inquiries:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
Claim Status/Patient Eligibility:
(866) 518-3285
24 hours a day, 7 days a week
Claim Corrections/Reopenings:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
EDI: (866) 518-3285
7:00am to 5:00 pm CT M-F
General Inquiries:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
Claim Status/Patient Eligibility:
(866) 234-7331
24 hours a day, 7 days a week
Claim Corrections/Reopenings:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
EDI: (866) 234-7331
8:00 am to 5:00 pm ET M-F
General Inquiries:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
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General questions about Medical Review
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Inquiries regarding overpayments NOT associated with MSP
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Reimbursement.Overpayment.
Inquiry@wpsic.com
Inquiries regarding refunds to Medicare - MSP Related
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Secondary.Payer.Inquiry@wpsic.com
Inquiries regarding overpayments NOT associated with MSP
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Reimbursement.Overpayment.
Inquiry@wpsic.com
Questions regarding overpayments associated with MSP related debt
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Secondary.Payer.Inquiry@wpsic.com
Questions regarding overpayments NOT associated with MSP related debt
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 6:00pm ET) M-Fri
Payment.Recovery.Inquiry@wpsic.com
Questions regarding overpayments associated with MSP related debt
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Secondary.Payer.Inquiry@wpsic.com
Questions regarding overpayments NOT associated with MSP related debt
(866) 234-7331
8:00 am to 5:00 pm ET (7:00 am to 4:00pm CT) M-Fri
Payment.Recovery.Inquiry@wpsic.com
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USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
(866) 234-7331
8:00 AM - 5:00 PM ET, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
(866) 518-3285
7:00 AM - 5:00 PM CT, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
(866) 234-7331
8:00 AM - 5:00 PM ET, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
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Questions about Payments and Incentive Programs
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Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
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Questions about Payments and Incentive Programs
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Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
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Financial.Reporting.Inquiry@wpsic.com
Do not submit PHI/PII through email
Questions about Payments, Fee Schedules, and Incentive Programs
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Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
(866) 518-3285
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Financial.Reporting.Inquiry@wpsic.com
Do not submit PHI/PII through email
Questions about Payments, Fee Schedules, and Incentive Programs
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
(866) 234-7331
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Financial.Reporting.Inquiry@wpsic.com
Do not submit PHI/PII through email
Need help?
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Mail audit materials:
WPS GHA
ATTN: Audit Supervisor
P.O. Box 8696
Madison, WI 53708-8696
When using a delivery service:
WPS GHA
ATTN: Audit Supervisor
1717 W. Broadway
Madison, WI 53713-1834
Mail audit materials:
WPS GHA
ATTN: Audit Supervisor
P.O. Box 14172
Madison, WI 53708-0172
When using a delivery service:
WPS GHA
ATTN: Audit Supervisor
1717 W. Broadway
Madison, WI 53713-1834
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Questions about Self-Service?
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Try these links first.
Questions about Self-Service?
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Questions about Self-Service?
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Modifier 59 Fact Sheet
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Definition: Distinct Procedural Service identifies procedures/services not normally reported together, but appropriately billable under the circumstances.
Appropriate Usage
- Documentation indicates two separate procedures performed on the same day by the same physician
- Represented by a different session or patient encounter, different procedure or surgery, different site, or separate injury (or area of injury)
- Use Modifier 59 with the secondary, additional or lesser procedure of combinations listed in National Correct Coding Initiative (NCCI) edits.
- Use Modifier 59 when there is no other appropriate modifier.
- Use Modifier 59 on the second initial injection procedure code when the IV protocol requires two separate IV sites or when the patient has to come back for a separately identifiable service.
Correct Use of Modifier 59 with Cytopathology Codes
When cytopathology codes are reported, the appropriate CPT code to bill is that which describes, to the highest level of specificity, what services were rendered. Accordingly, for a given specimen, only one code from a group of related codes describing a group of services that could be performed on a specimen with the same end result (e.g., 88104-88112, 88142-88143, 88150-88154, 88164-88167, etc.) is to be reported. If multiple services (i.e., separate specimens from different anatomic sites) are reported, modifier -59 should be used to indicate that different levels of service were provided for different specimens from different anatomic sites. This should be reflected in the cytopathologic reports.
Inappropriate Usage
- Code combination not appearing in the NCCI edits
- Submission of Evaluation and Management (E/M) Codes
- Submission of weekly radiation therapy management codes (CPT 77427)
- The NCCI tables lists the procedure code pair with a modifier indicator of "0"
- Documentation does not support the separate and distinct status
- Exact same procedure code performed twice on the same day
- Multiple administration of injections of the same drug
- If a valid modifier exists to identify the services
global-tags: J8A,J5A,J8B,J5B,Claims
Need help?
Contact Us About Claims
Claim Status/Patient Eligibility:
(866) 518-3285
24 hours a day, 7 days a week
Claim Corrections:
(866) 518-3253
7:00 am to 4:30 pm CT M-Th
DDE Navigation & Password Reset: (866) 518-3251
7:00 am to 4:30 pm CT M-F
DDE System Access: (866) 518-3295
7:00 am to 4:30 pm CT M-F
EDI: (866) 518-3285
7:00 am to 5:00 pm CT M-F
General Inquiries:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
Claim Status/Patient Eligibility:
(866) 234-7331
24 hours a day, 7 days a week
Claim Corrections:
(866) 580-5980
8:00 am to 5:30 pm ET M-Th
DDE Navigation & Password Reset: (866) 580-5986
8:00 am to 5:30 pm ET M-F
DDE System Access: (866) 518-3295
8:00 am to 5:30 pm ET M-F
EDI: (866) 234-7331
8:00 am to 5:00 pm ET M-F
General Inquiries:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
Claim Status/Patient Eligibility:
(866) 518-3285
24 hours a day, 7 days a week
Claim Corrections/Reopenings:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
EDI: (866) 518-3285
7:00am to 5:00 pm CT M-F
General Inquiries:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
Claim Status/Patient Eligibility:
(866) 234-7331
24 hours a day, 7 days a week
Claim Corrections/Reopenings:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
EDI: (866) 234-7331
8:00 am to 5:00 pm ET M-F
General Inquiries:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
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