Physician Practice

CMS releases new MLN Matters article on modifier -59 use in 2015

Physician Practice Insider, January 27, 2015

On January 23, CMS released MLN Matters article SE1503, Continued Use of Modifier 59 after January 1, 2015, to alert physicians and other providers regarding the continued permissible use of the modifier.

With the article, CMS is aiming to eliminate confusion regarding its earlier Change Request (CR) 8863, which took effect January 1. This CR established the new -X modifiers (i.e., -XE, -XP, -XS, and -XU) as appropriate for use in delineating subsets of modifier -59 use. Further guidance on the use of these modifiers is forthcoming, according to CMS.

Through the following new modifiers, CMS hopes to gain a better understanding of the types of services providers previously reported with the more generic modifier -59:

  • -XE, separate encounter, a service that is distinct because it occurred during a separate encounter
  • -XS, separate structure, a service that is distinct because it was performed on a separate organ/structure
  • -XP, separate practitioner, a service that is distinct because it was performed by a different practitioner
  • -XU, unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service

In its initial transmittal, the agency states, “CMS will continue to recognize the -59 modifier in many instances but may selectively require a more specific -X{EPSU} modifier for billing certain codes at high risk for incorrect billing.”

The MLN Matters article clarifies this, saying, in short, “providers may continue to use the -59 modifier after January 1, 2015, in any instance in which it was correctly used prior to January 1, 2015.”

“What may be confusing for providers initially is that CMS is not going to stop recognizing modifier -59. In fact, the agency is only requesting the ‘more descriptive modifiers’ be reported, but it's only going to be a matter of time before CMS begins requiring the new modifiers,” Jugna Shah, MPH, president and founder of Nimitt Consulting, previously explained to HCPro. “What we do know is that what CMS is calling the -X{EPSU} modifiers cannot be reported alongside modifier -59. CMS says that it would be incorrect to include both modifiers on the same line.”

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