New X Modifiers and Modifier 59

CMS requires that state Medicaid programs implement the methodologies of the National Correct Coding Initiative (NCCI). There are four new HCPCS modifiers; XE, XP, XS, and XU that will be established on January 1, 2015, that should be added to the list of PTP-associated modifiers for Medicaid claims. Modifier 59 will remain a valid PTP-associated modifier. However, the coding instructions for modifier 59 specify that it should be used “only if no more descriptive modifier is available”. Therefore, providers should use one of the new modifiers, instead of modifier 59, if the clinical situation described by one of the new modifiers is present. It is important that these changes be implemented for Medicaid claims with dates of service on or after January 1, 2015, because failure to do so may result in the inappropriate denial of claims.