CMS Introduces Four New Modifiers for 2015

Centers for Medicare & Medicaid Services (“CMS”) has announced that four new modifiers will refine the use of the 59 modifier effective January 1, 2015. These new modifiers, referred to as the X modifiers, will describe the circumstances appropriate to override a CCI edit.

The introduction of the X modifiers is designed to reduce improper use of modifier 59 and improve claims processing for providers. Descriptions of the X modifiers are 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

While CMS will continue to recognize modifier 59, it has made clear that modifier 59 should not be used when a more descriptive modifier is available. CMS MLN: MM8863 and CMS transmittal CR 8863 contain further information on the new modifier changes for 2015. If you have any questions relating to this CMS announcement or proper modifier usage, please don’t hesitate to contact Precision.