Communication Related to Modifiers from the PT, OT, and ST National Organizations

APTA:

(September 29, 2014)

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

AOTA:

(November 5, 2014)

Occupational Therapists Should Continue Modifier 59 Use

CMS recently released transmittal 1422 describing specific modifiers to be used in place of Modifier 59 (referred to as “the X{EPSU} modifiers”) for distinct procedural services. AOTA reached out to CMS for more clarification regarding the use of these new modifiers. For now, the new modifiers will not apply to occupational therapy services. OTs can continue to use Modifier 59.

      • Occupational therapists can keep using the 59 modifier until CMS issues specific instructions about the use of the new X{EPSU} modifiers.
      • Because the X{EPSU} modifiers were developed to be used in the place of the 59 modifier, the XP modifier (used to indicate a different “practitioner”)  is not appropriate to use at this time to distinguish between therapy disciplines as CMS uses the therapy modifiers — GN, GO, or GP — to track and differentiate between the 3 therapy disciplines.
      • For purposes of applying the NCCI edits for outpatient therapy services, you can continue to use the 59 modifier, rather than the X{EPSU} modifiers, to denote distinct therapy procedures until such time CMS issues future clarifying instructions.

– See more at: http://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/Coding/Occupational-Therapists-Should-Continue-Modifier-59-Use.aspx#sthash.S9i33Rs1.dpuf

ASHA

(November 12, 2014)

Medicare Clarifies Billing Modifiers for Therapy Services

A meeting between ASHA and Centers for Medicare & Medicaid Services (CMS) officials provided guidance to speech-language pathologists regarding use of the Healthcare Common Procedure Coding System (HCPCS) modifier -59, a modifier that is used to define a “Distinct Procedural Service.” Speech-language pathologists use the modifier -59 on several codes subject to the National Correct Coding Initiative (NCCI). The modifier indicates and attests that codes billed on the same date of service are separate and distinct from another service with which it may be considered to be bundled.

In August, CMS established four new modifiers to distinguish situations where specific code pairs that are “at risk” of incorrect billing. CMS has not yet released the code pairs that are subject to the new modifiers. However, it was clarified that the speech-language pathology services subject to the NCCI edits are not currently subject to the new modifiers and the modifier -59 should continue to be used until CMS releases additional instructions.

At this time, speech-language pathologists should not have to change their billing practices for specific code pairs and should continue to use the modifier -59 as indicated.

ASHA also asked if the new modifiers applied to audiology services, and CMS indicated that this has not yet been determined. Specific code pairs and instructions for modifier use will be released “in the near future.”

As more information becomes available, ASHA will update members through ASHA Headlines and on the webpages listed as ASHA Resources.