Medicare Compliance & Reimbursement - 2014 Issue 30
Modifiers: CMS Debuts 4 New Modifiers to Substitute for -59
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Article Overview
This article reviews CMS and MLN Matters guidance on new HCPCS modifiers and the continued role of modifier 59. It is relevant to coders, billing staff, compliance teams, and Medicare-focused practices that need to track CMS updates, selective editing, and local MAC requirements affecting modifier use.
Why This Topic Matters
The article matters because it highlights a CMS effort to reduce misuse of a widely used modifier and shift reporting toward more specific options when appropriate. It also signals that Medicare acceptance, CMS editing, and MAC-level requirements may change over time, which can affect billing workflows and compliance monitoring.
Article Sections
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CMS guidance on modifier 59 and new X(EPSU) modifiers
Overview of the CMS discussion about modifier use, related Medicare guidance, and the introduction of more specific reporting alternatives. The section places the update in the context of compliance and editing changes.
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Acceptance, implementation, and local requirements
Discussion of when the new modifiers are expected to be accepted, how CMS describes the transition period, and the possibility of Medicare contractor-specific requirements. The section also addresses limits on combining modifiers on a claim line.
What You Will Learn
- What CMS is trying to change about modifier reporting
- How the new modifier family is positioned in Medicare guidance
- What types of CMS and MAC policy changes may affect billing practices
- How the article frames the transition away from broad modifier use
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Revenue cycle teams
- Medicare billing specialists
- Practice managers
Modifiers Discussed
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