A question was recently asked from one of our clients:
“what will be the effect of the CMS change for modifier 59”. See the below:
The proposed four new CMS “X” (EPSU) modifiers (“XE”, “XS”, “XP”, and “XU”) are used to be more descriptive than the “59” modifier in the case of separate, but distinct treatments being billed. In the case of therapists, these may include separate but distinct treatment protocols that have different CPT treatment codes and are performed during the same day. There are a lot of possibilities for PT and OT treatment protocols for these pairs, as well as some for SLPs. So this would apply to therapists.
However, in the case of these proposed changes, which are slated to start on 1/15/2015, the AOTA, APTA, and ASHA have aggressively sought clarification from CMS as to the effects on therapy treatment billing using these new proposed modifiers for 2015. The answer was, “therapists can continue to use the 59 modifier as before” until more clarification is given for treatment NCCI edit CPT pairs applicable under the use of these new modifiers.
You may be asking, “why the new modifiers?” In four words, “fraud and error prevention”. The modifier “59” was being overused, abused, and mostly, misused by some providers (to the tune of something like $320M a year) when performing distinct treatment codes and these more descriptive modifiers “paint them into the corner” as to what exactly they really mean doing those treatments together.