Continued Use of Modifier 59 after January 1, 2015

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1503.pdf

The Centers for Medicare & Medicaid Services (CMS) implemented Change Request (CR) 8863 on January 5, 2015, effective January 1, 2015. This CR established four (4) 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 were scheduled to replace the -59 modifier effective January 1, 2015, but new instructions will allow continued use of -59 along with the new –X modifiers.

These modifiers are collectively referred to as –X {EPSU} modifiers. Please note that 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.

The four new HCPCS modifiers selectively identify subsets of Distinct Procedural Services (-59 modifier) as follows:

• 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

The initial CR establishing the modifiers was designed 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 will be forthcoming as CMS continues to introduce the modifiers in a gradual and controlled fashion. That guidance will include additional descriptive information about the new modifiers. CMS will identify situations in which a specific –X {EPSU} modifier will be required and will publish specific guidance before implementing edits or audits.

CR 8863 states that providers who wish to use the new modifiers may use them in accordance with their published definitions, and the X 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.

An article describing usage scenarios may be found at:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf

CR 8863 is available at:
http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1422OTN.pdf

A related MLN Matters® article is available at:
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8863.pdf

Back to top
Lymphedema Treatment is Good Business as well as Good Medicine
© 2002 Robert Weiss, Porter Ranch, CA