Beginning with January 1, 2018, dates of service, Medicare claims should include patient relationship HCPCS modifiers (see below), as well as the NPI of the ordering physician or applicable practitioner (if different from the billing physician or applicable practitioner).
The Centers for Medicare and Medicaid Services (CMS) has made this a voluntary policy for now, “while clinicians gain familiarity,” and the use and selection of the modifiers will not be a condition of payment.
The new patient relationship modifier codes are as follows:
|No.||HCPCS Modifier||Patient Relationship Categories|
|5x||X5||Only as ordered by another clinician|
Reporting patient relationship codes was mandated through the The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), requiring the development of patient relationship categories and codes “that define and distinguish the relationship and responsibility of a physician or applicable practitioner with a patient at the time of furnishing an item or service.”
For more information, see pages 743-753 of the 2018 Medicare Physician Fee Schedule Final Rule.
— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at firstname.lastname@example.org.