In August, the Centers for Medicare & Medicaid Services (CMS) released an article that may affect the continued acceptance of Current Procedural Terminology (CPT®) modifier 59, distinct procedural service. This change will affect not only billing for Medicare but also Medicaid and, potentially, private health plans as well. MLN Matters article MM8863 (PDF available online at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8863.pdf) introduces 4 new Healthcare Common Procedure Coding System (HCPCS) modifiers (referred to collectively as X {EPSU} modifiers). These modifiers will be implemented on January 5, 2015, and define specific subsets of modifier 59.

Before reviewing the new modifiers, it may be helpful to review the use of modifier 59. Modifier 59 is used to indicate that a service is distinct or independent from other procedural services provided on the same date. This modifier is not applicable to evaluation and management services. Per CPT, modifier 59 represents...

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