Experts: PT Network Appears to be Inflating Bills Using Coding Modifier

Insurers and employers have begun to notice a suspicious influx of modifiers appended to billing codes for physical therapy services that they say inflate prices beyond what they should be. Joe Paduda, principal of the managed care firm Health Strategy Associates, said some payers have noticed that nearly all of the bills coming through an unnamed physical therapy network since 2009 have included the number “59” — a Current Procedural Terminology code modifier attached to a bill to indicate that two services performed in succession should be reimbursed separately. The m...