The Centers for Medicare & Medicaid Services (CMS) has made a significant change to the policy for using distinct service modifiers to override Medicare National Correct Coding Initiative (NCCI) edits. The change will be implemented July 1, 2019.

Although the Medicare NCCI edits are maintained for use in the Medicare program, these bundling edits are used by many payers (although, at times, with health plan–specific modifications). Pediatric practices should watch for changes by other payers, including Medicaid and the Children’s Health Insurance Program, and monitor payer communications and online policies.

Beginning July 1, 2019, physicians may append modifiers 59, XE, XP, XS, and XU to either the column 1 or column 2 code when reporting 2 codes paired by Medicare NCCI edits. For services reported prior to July 1, 2019, the appropriate modifier must be appended to the column 2 code to override an edit that...

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