Blue Review - Blue Cross and Blue Shield of Oklahoma

 
 

May 7, 2015

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. Following are the new modifiers replacing modifier 59 and their descriptions:

X Modifier

CMS Descriptions

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 Oklahoma (BCBSOK) will enhance the ClaimsXten code auditing tool by adding the first quarter 2015 codesand bundling logic into our claim processing system. Currently, BCBSOK 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 ConnectionTM (C3). C3 is a free, online reference tool that mirrors the logic behind BCBSOK’s code-auditing software. Refer to our website at bcbsok.com/provider for additional information on gaining access to C3.

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

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

CPT Copyright 2014 AMA. All rights reserved. CPT is a registered trademark of the AMA.

 


 Blue Cross and Blue Shield of Oklahoma is a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.