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New Patient Relationship Modifiers Are Voluntary for Medicare Claims

New Patient Relationship Modifiers Are Voluntary for Medicare Claims

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
1x X1 Continuous/broad services
2x X2 Continuous/focused services
3x X3 Episodic/broad services
4x X4 Episodic/focused services
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.

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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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