As a reminder…..CMS has established four new HCPCS modifiers to define subsets of the -59 modifier
CPT Definition of -59 Modifier: Distinct Procedural Service
Purpose of Subsets:
- Prevent Fraud & Abuse
- Reduce number of reviews & appeals
- Help providers assign this code properly
New Modifiers & Meanings:
- XE Modifier: Separate encounter i.e. a service that is distinct because it occurred during a separate encounter.
- XS Modifier: Separate structure i.e. a service that is distinct because it was performed on a separate organ/structure.
- XP Modifier: Separate Practitioner i.e. a service that is distinct because it was performed by a different practitioner.
- XU Modifier: Unusual Non-Overlapping Service i.e. the use of a service that is distinct because it does not overlap usual components of the main service
- Implementation date is January 5, 2015
- CMS will continue to recognize the -59 modifier, but it should NOT be used in addition to these new modifiers because they are more descriptive.
- CMS may make the use of these modifiers mandatory when used to bill certain codes that are considered at high risk for incorrect billing.
- These modifiers are valid even before national edits are in place. Providers are encouraged to use the more selective modifiers. MAC’s are not prohibited from requiring the use of selective modifiers in lieu of the general -59 modifier.
If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp; Coding & Credentialing Manager at 716.348.3904 or firstname.lastname@example.org