Modifiers back from the dead?

by: Laura Evans Apr 12, 2016

After CMS appeared to backpedal from using the X modifiers in a call with providers a year ago, you might have concluded that Medicare was setting these HCPCS modifiers aside. In fact, coders from around the country at this year's AAPC HealthCon report that their Medicare administrative contractors are still accepting them. According to the coders, here are some states where X modifiers may be used in place of modifier 59: Alabama, California, Florida, Georgia and Pennsylvania. Check with your MAC on its preference regarding the modifiers. Payers should welcome the modifiers, noted speaker Raemarie Jimenez, because they help providers relay more specific information about why specific code pairs should be billed together.

Another modifier that appears to be making a resurgence: modifier 51. For years, many MACs and private payers appear to have discouraged practices from appending the modifier because their own claims-processing systems already identified multiple procedures and reduced payment accordingly. But an informal poll of coders attending a session on surgery auditing showed that many Medicare contractors still require 51, including those for Colorado, Florida, Illinois, Iowa, Maine, Maryland, Pennsylvania and Texas.

Blog Tags: claims processing, CMS, MACs

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TONI HYDE

May 13, 2016 5:01 PM

does anyone know where NY State stands on this topic? Do we use them or don't we?

TONI HYDE

May 13, 2016 5:01 PM

does anyone know where NY State stands on this topic? Do we use them or don't we?

TONI HYDE

May 13, 2016 5:01 PM

does anyone know where NY State stands on this topic? Do we use them or don't we?

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