Becker's ASC

2015 CMS modifier -59 reporting change: 4 new modifiers added

The Centers for Medicare and Medicaid Services acknowledges that there are code combinations that may warrant an exception in reporting based on clinical documentation. Coders tend to err on the side ...
The American Journal of Managed Care

Avoiding Risk Using New X Modifiers for Medicare Reimbursement

On January 1, 2015, the Centers for Medicare & Medicaid Service (CMS) introduced 4 Healthcare Common Procedure Coding System modifiers, known collectively as the - X(EPSU) modifiers, as a subset of ...
Becker's ASC

3 Critical Mistakes Made When Reporting Modifier -59

3. Over-utilization of -59. Do not use -59 to bypass the edits when a procedure is truly integral to the main procedure. Remember, simply because the Medicare edits may allow for a modifier doesn’t ...
JD Supra

340B Update for Hospitals: CMS Publishes FAQs Clarifying Use of Modifiers in Connection with 340B Program Reimbursement Cut on Part B Drugs

On December 13, 2017, the Centers for Medicare & Medicaid Services (“CMS”) published subregulatory guidance to answer questions about billing for drugs acquired through the 340B Drug Pricing Program ( ...
Healio

Modifying the modifier

In addition to the creation of several new CPT codes for 2015, one CPT change is not about a new code but rather an old modifier. Modifier –59 is used when we want to communicate with the insurance ...
Health Affairs

Performance And Participation Of Physicians In Year One Of Medicare’s Value-Based Payment Modifier Program

In 2015 Medicare launched the Physician Value-Based Payment Modifier program, the largest US ambulatory care pay-for-performance program to date and a precursor to the forthcoming Merit-based ...