Association News

Changes to 59 Modifier Coding Bypass PTs

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The American Physical Therapy Association (APTA) reports that for the time being, physical therapists will not be affected by additional requirements around an important Medicare coding modifier being instituted by the US Centers for Medicare and Medicaid Services (CMS).

A media release from the APTA indicates for the time being therapists may continue to use the 59 modifier under the Correct Coding Initiative.

Gayle Lee, JD, APTA senior director of health finance and quality notes that association members are posing questions regarding use of several new modifiers issued by CMS. Lee says that at this time therapists do not have to use the new modifiers.

“As of February, 2015, PTs are being instructed that these new modifiers are not required for physical therapist services. However, at some point in the future, PTs may need to use these new modifiers instead of the 59 modifier, so it’s important that they stay abreast with this change as implementation continues,” Lee says.

The APTA’s media release notes that the changes announced by CMS in August 2014 apply to the 59 modifier in payment claims. The 59 modifier is described by the APTA as the code under the health care common procedural code system used to represent a service that is separate and distinct from another service it’s paired with. The APTA states that in an effort to tease out precisely why the service is distinct, CMS is requiring some providers to use different modifiers instead of the 59 modifier. The new modifiers—XE, XP, XS, and XU—are intended to bypass a CCI edit by denoting a distinct encounter, anatomical structure, practitioner, or unusual service.

APTA reports that it will continue to monitor this issue advise of any changes.

[Source: American Physical Therapy Association]