New Modifiers to Supplement 59

Coding and BillingNo Comments

modifier59CMS announced four new modifiers that will go into effect January 5, 2015.  These modifiers are to be used in lieu of modifier 59, Distinct Procedural Service.  The new modifiers provide more specificity and will help to identify the different sub-sets of instances where modifier 59 is traditionally used. The four new modifiers are as follows:

Modifier XE, Separate Encounter. A service that is distinct because it occurred during a separate encounter.

Modifier XS, Separate Structure. A service that is distinct because it was performed on a separate organ/structure.

Modifier XP, Separate Practitioner. A service that is distinct because it was performed by a different practitioner.

Modifier XU, Unusual Non-overlapping service. The use of a service that is distinct because it does not overlap usual components of the main service.

Modifier 59 can still be used, however, when more specific modifiers are available, they should be used. 

These new modifiers are designed to reduce the improper use of modifier 59 and improve the claims processes for providers.
For more information, visit: http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1422OTN.pdf


Comments
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  1. Karl Eichinger November 22, 2014

    I am in the reimbursement methodologies section of the program. Is this going to be on the final? I have until September 11th until completion.

  2. Instructor Rebecca Brailsford December 09, 2014

    Hi Karl,

    There are 11 modules after the reimbursement methodologies; check out the study planner to see the estimated number of hours it takes to complete each module. The study planner will also show how many pages will need to be completed daily to finish by a specific date. Yes, it is possible to finish by next September!

    Good luck!


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