CMS Announces New HCPCS Modifiers to be Implemented January 2015

by 
December 23rd, 2014

Beginning January 5, 2015 CMS (Centers for Medicare and Medicaid Services) requires new HCPCS modifiers to be used in place of modifier 59 for all Medicare claims.

These new subset modifiers are known as -X{ESPU} and are defined 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

Why the change?

Modifier 59 is the most widely used HCPCS modifier across the medical profession. As a result, it has been determined that the definition of the 59 modifier is too broad and often used
incorrectly. To resolve the misuse of the 59 modifier, the -X{ESPU} modifiers listed above have been established.

It is important to note that commercial payers are not required to make this transition as well
and it is unclear at this time if/which payers are implementing this change. Where the 59
modifier is not generally used on Medicare claims for chiropractic, the impact of this change may be minimal to chiropractic. However, historically CMS has established the standard for
which other payers align with. Providers are encouraged to obtain and review updated LCD
(Local Coverage Determination) information and additional publications that may be issued
by local Medicare Contractors to be confident of individual requirements for use of these
new modifiers. Additionally, providers should obtain any updated information available from
commercial payers to determine which/if other payers are following Medicare's lead with this
change.

http://www.mdeverywhere.com/big-changes-by-medicare-for-the-59-modifier/