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News & Press: Insurance/Provider

Is Modifier 59 Going Away?

Wednesday, December 3, 2014   (0 Comments)
Posted by: Sheri Ryan
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Anyone who uses modifier 59 needs to be aware that due to problems with the incorrect usage of this modifier (which by the way is also revised for 2015,) CMS has added four new HCPCS modifiers. An announcement by CMS stated that “CMS is establishing four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.”

These new codes are:

  • 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

 “CMS will continue to recognize the -59 modifier, but notes that Current Procedural Terminology (CPT) instructions state that the -59 modifier should not be used when a more descriptive modifier is available.”

These codes will replace the use of modifier 59 where applicable. Providers and coders need to ensure that patient documentation appropriately identifies the rationale for code selection.

It should be noted that CMS recognizes that modifier 59 has the potential for abuse and will be requiring the use of these new modifiers in January 2015. For this reason, it is highly likely that claims reported with modifier 59 will be closely scrutinized. Be sure that all staff are aware of and understand the proper use of these new codes.

Because other payers often follow CMS policies, watch for announcements by other payers regarding the use of these new modifiers.

The complete announcement by CMS includes a more detailed discussion regarding the improper use of this modifier.  See to review the complete announcement.

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