Get to know CMS’ four new subsets of modifier -59

Why This Topic Matters

Organizations that bill Medicare and outpatient services need to understand changing CMS modifier guidance to reduce claim errors, support compliance, and anticipate future edits or documentation expectations.

Article Sections

1. Overview of CMS changes

   Introduces the topic and summarizes the scope of CMS’ changes affecting modifier guidance for 2015.

2. Why CMS acted

   Reviews the policy background and the government’s concern about modifier use and claims error patterns.

3. CMS’ solution

   Summarizes the new HCPCS modifier subsets and the general purpose CMS assigns to them.

4. What will happen to modifier -59?

   Discusses how CMS may phase in use of the newer modifiers and what providers may need to monitor over time.

5. Questions and additional guidance

   Notes where providers are directed to seek further clarification as new questions arise.