Blue Review - Blue Cross and Blue Shield of Texas

CMS replaces modifier 59 with new “X” modifiers

Effective Jan. 1, 2015, the Centers for Medicare & Medicaid Services (CMS) added four new modifiers to replace modifier 59 when submitted with Current Procedural Terminology (CPT^®’)/HCPCS codes. Modifier 59 was previously used to report that a service was a distinct procedural service. The new modifiers and their descriptions are:

X Modifier	Description
XE Separate Encounter	A service that is distinct because it occurred during a separate encounter
XS Separate Structure	A service that is distinct because it was performed on a separate organ/structure
XP Separate Practitioner	A service that is distinct because it was performed by a different practitioner
XU Unusual Non-Overlapping Service	The use of a service that is distinct because it does not overlap usual components of the main service

Beginning on or after April 20, 2015, Blue Cross and Blue Shield of Texas (BCBSTX) will enhance the ClaimsXten code auditing tool by adding the first quarter 2015 codesand bundling logic into our claim processing system. Currently, BCBSTX will accept the new modifiers when submitted.

To help determine how coding combinations on a particular claim may be evaluated during the claim adjudication process, you may use Clear Claim Connection^TM (C3). C3 is a free, online reference tool that mirrors the logic behind BCBSTX’s code-auditing software. Refer to the BCBSTX provider website for additional information on gaining access to C3.

For more details regarding ClaimsXten, including answers to frequently asked questions, refer to the Education & Reference/Provider Tools/ Clear Claim Connection page on our provider website. Information also may be published in upcoming issues of Blue Review.

ClaimsXten and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc., an independent third party vendor that is solely responsible for its products and services.

BCBSTX makes no endorsements, representations, or warranties about any products or services offered by
independent third-party vendors mentioned in this newsletter. The vendors are solely responsible for the products or
services offered by them. If you have any questions about the products or services mentioned in this newsletter,
contact the vendor directly.

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Blue Review • May 2015 • www.bcbstx.com