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Experience. Integrity. Advocacy.

New Modifiers Are Available, but CMS Says -59 Mod Works Just Fine For Now


In January, the Centers for Medicare and Medicaid Services (CMS) established four new HCPCS modifiers (XE, XP, XS, XU) to define specific subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.” These modifiers are collectively referred to as –X {EPSU} modifiers.

While these new modifiers are now valid for use, their initial release was designed simply to inform system developers that healthcare systems would need to accommodate the new modifiers. Additional guidance and education as to the appropriate use of the new –X {EPSU} modifiers, including additional descriptive information about the new modifiers and situations in which a specific –X {EPSU} modifier will be required, will be published before implementing edits or audits.

As such, 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. In fact, in an April 14 Physician Open Door Call, Dan Duvall, Medical Officer in the CMS Hospital and Ambulatory Policy Group, said there really is no advantage to making the change to the new –X {EPSU} modifiers at this time. “It’s acceptable to use the -59 modifier exactly as you have been using it appropriately in the past,” he told listeners. Duvall also indicated that CMS currently has no specific implementation date in mind.

Providers who wish to use the new modifiers may use them strictly in accordance with their published definitions. According to MLN Matters Number: SE1503, the –X {EPSU} modifiers will function within CMS systems in the same manner as the 59 modifier, bypassing Procedure-to-Procedure (PTP) edits with a modifier indicator of “1,” for example. A modifier indicator of “1” indicates that NCCI-associated modifiers may be used to bypass an edit under appropriate circumstances.

For more information, the MLN Matters Number: MM8863 highlights all the new modifiers and explains the reasons they are being established.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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