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Area 59 Modifier 59 the X File-ing codes

Recent The X File-ing Codes rumblings from the US Centers for Medicare and Medicaid Services (CMS) has suggested that Modifier 59time might be up. Meaning more headaches when putting together your claim and more rules to learn about.

So what exactly did CMS change and when is it in effect?

Retroactively effective from the very first day of 2015, Change Request (CR) 8863 was implemented, it details the phasing out of Modifier 59in instances where services rendered were separate and distinct from the service it’s billed with. CMS are proposing four new HCPCS modifiers, (XE, XP, XS, XU), these will bypass CCI edit rules by indicating either a practitioner, a distinct encounter, an anatomical structure, or even an unusual service.

Now, while these are already in effect they are not mandatory, in fact in the same statement CMS stated that what was accepted as correct usage of Modifier 59prior to the change will still be considered correct usage for 2015.but for how long???

While CMS has not announced an official phasing out date or timetable for mod 59 (so theoretically it may not be for a while) however, it is in your best interest to start acclimating yourself to the new modifiers now as CMS have already issued guidelines on their use and already accepting their submission!

CMS in their generosity are offering a wealth of knowledge and guidance on correct usage of the new modifiers. Make sure to be prepared, take them up on their offer, collect the data, do a little studying and avoid the inevitable headache and confusion!