2015 Useful New Modifiers for Physical Therapy Billing and Coding

2015_Medicare_Modifier_59_Changes_with_4_New_ModifiersBeginning January 1, 2015 – CMS had developed 4 new Modifiers that can be useful for therapy service provider. As a consultant helping many of my therapy service provider-clients, I think this could would be more appropriate to use than the modifier 59

These new modifiers are subsets of Modifier 59

For example, using modifier XS when you are treating a patient with two different anatomic site (knee, and back) … this is an appropriate modifier to use.

97110 –                (DX Pointer- Code V43.65, 717.9)
97110 – XS          (DX Pointer- Code 724.4)

Say hello to your 2015 Useful New Modifiers for Physical Therapy Billing and Coding

Modifier XE Separate encounter: A service that is distinct because it occurred during a separate encounter

Modifier XP Separate practitioner: A service that is distinct because it was performed by a different

Modifier XS Separate structure: A service that is distinct because it was performed on a separate organ/structure

Modifier XU Unusual non-overlapping service: The use of a service that is distinct because it does not overlap usual components of the main service

Reference: 2015 CMS Modifier 15 Changes Transmittal 1422 CR 8863

Although, CMS will continue to recognize Modifier -59 but you have to make sure you will only utilize modifier 59 when there is no other specific modifier that may describe your “distinct” procedure service. When using this modifier, Medical Documentation is vital and essential to support medical necessity. This must be well-documented on the patient’s medical record.

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Author: Pinky Maniri

Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

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