CMS to Hold on Implementing -59 Modifier Subset for Therapy Providers

Earlier this year, CMS announced that it had established four new modifiers to define subsets of the -59 modifier.  According to CMS, because of its broad application, the -59 modifier is the most widely used modifier and has become associated with abuse and high levels of manual audit activity.  As a result, CMS defined four new HCPCS modifiers which will be collectively referred to as -X{EPSU} modifiers to selectively identify subsets of Distinct Procedural Services (-59 modifier).  (See previous blog entry from September titled “CMS Establishes New Modifiers to Define Subsets of -59 Modifier.”)

However, CMS recently communicated that it will NOT implement the four new subsets for outpatient therapy services at this time and that therapy providers are to continue to use the -59 modifier as they have done in the past until further guidance is provided regarding the -X{ESPU} modifiers. If CMS decides later to implement the modifier subsets for outpatient therapy, it will release additional instructions on how to appropriately apply the modifier subset.

We will certainly keep our eyes and ears open for any further announcements regarding the -59 or -X{ESPU} modifiers.