CMS' Subset Modifiers for Modifier 59 Possibly on Hold
Written by Editor   
Wednesday, December 31, 2014 04:25 PM

On December 10th, ACA sent out a release to members concerning the new subset of modifiers for modifier 59 that were proposed by CMS in August, 2014. The new subset modifiers were proposed by CMS in August to provide greater detail in outlining the specific need for where the 59 modifier should be used.  ACA strongly advises providers to continue using modifier 59 according to standard CPT directives.

The following are the new subset modifiers:

  • 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

Although DCs are not reimbursed at this time for rehabilitation codes under Medicare, if you practice with PTs and you need further instructions regarding this change, ACA strongly recommends you contact your local MAC and review their updated resources on this subject. 

Commercial payers may begin to use these subset codes at some point.  With this in mind, ACA has continued to monitor CMS and other sources for any updates that would impact the chiropractic profession, and the latest information received hints towards delay of implementation.  Because each MAC's Local Coverage Determination (LCD) may have variations, the ACA strongly advises providers to continue using modifier 59 according to standard CPT directives.

Please stay alert to any information on this issue so that reimbursement will not be delayed for your practice.