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  • CMS Says Keep Using 59 Modifier for Now

    Until you receive further notice, keep on using the 59 modifier in reimbursement claims to indicate that a health care common procedural code (HCPCS) represents a service that is separate and distinct from another service to which it is paired under the Correct Coding Initiative (CCI) program—that's the bottom line from the Centers for Medicare and Medicaid Services (CMS), which recently responded to an inquiry from APTA as to when—and whether—physical therapists should use a set of new modifiers announced by CMS in August.

    The clarification was forwarded to APTA by CMS after some physical therapists questioned whether they should begin using the new modifiers. The CMS answer: not yet.

    In August, CMS issued a transmittal describing new modifiers—XE, XS, XP, and XU—intended to be used to define subsets of the 59 modifier. The new modifier codes have not been implemented, and CMS has advised that PTs should not use the modifiers until they receive further notice.


    • Is there a more recent update to this since September?

      Posted by Robert Maroon -> EHRb on 12/30/2014 10:08 AM

    • Any updates for the new year?

      Posted by Jamie Ligon -> AFVZCH on 1/6/2015 8:28 AM

    • Your last post was from Sept. We have seen info from other entities that we are not supposed to use the new codes yet even though I have not been able to find anything on CMS's or Cahaba's website to say otherwise. I called Cahaba and was told that there was no delay that the codes went into effect on 1/5/15. Help please!

      Posted by Linda Wyrick on 1/8/2015 8:25 AM

    • Participated CMS contractor webinar on this subject (WPS on 1/6/15). Reported they had not received any direction from CMS regarding therapy to continue to use 59 for now and thus are going with the transmittal: providers, including therapy should implement the new modifiers. In response to the following scenario I provided: PT provides 15 minutes of cervical mech Tx (97012) and immediately follows with manual therapy to cervical soft tissue (97140) for an additional 15 minutes, which X modifier should PT use? WPS opined since each CPT was provided in separate and distinct 15 minute intervals, although during the same patient visit/encounter PT should use the XE modifier.

      Posted by Josita de Haan-Kicmal -> =KW^? on 1/8/2015 12:06 PM

    • Hi. I am seeing a patient for ankle pain and gait instability. I am seeing the patient for manual therapy and functional training. Which modifier should I use?

      Posted by ARADHANA SHARMA on 1/20/2015 12:22 PM

    • Hello any news on when and how the 59 and new X modifiers are to be used, and is there any type of education on this available?

      Posted by catherine renzi on 1/20/2015 12:23 PM

    • Please advise if you have any additional information on what X mod should be used in place of the 59?? We have multiple commercial carriers who now require the use of these X mods. There isn't a appropriate X mod given to use?

      Posted by Kristi May on 1/23/2015 12:01 PM

    • Can you please share the written clarification documentation that APTA received from CMS regarding therapists are to continue to use the 59 modifier. Several previous posts have shared the problem we are facing with our MACs and Compliance Advisors who have no access to this information.

      Posted by Maureen Hardy -> =NQZ= on 2/2/2015 2:59 PM

    • Can you please update the status of the requirement (or not) for use of the modifier 59 subset? We receive regular newsletters from Gawenda Consulting who is offering training in the use of the modifiers, the implication being that we should be using them. If APTA could address the status of the issue heading in to 2016 for members, it would be a great service.

      Posted by Elizabeth Hampton -> =GY_EF on 12/8/2015 10:27 AM

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