New Subsets of Modifier 59 Not Being Implemented in Outpatient Therapy Settings

December 17, 2014
Rick Gawenda

The Centers for Medicare and Medicaid Services (CMS) has responded to an inquiry by the American Physical Therapy Association, American Occupational Therapy Association and the American Speech-Language-Hearing Association as to when and whether physical therapists, occupational therapists and speech-language pathologists should use a new subset of modifiers that CMS announced in August 2014. At this time, CMS states for providers of outpatient therapy services to

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  1. This is the first I have read about the new modifiers NOT being implemented. Is this confirmed such that the continued use of 59 is what practices are to do?

    1. The story is on my website for my Gold Members and where to read about it. This is the benefit of belonging!

  2. Hello Rick, I was looking for something in writing to support the delay in the modifer 59 subsets for therapy. I called our MAC which is Cahaba and was told that there was no delay in CR8863. Can you direct me to where I can find this information please?

    1. If you are a Gold Member of our website service, please check out Current News for the information you are requesting.

  3. CMS stated they are leaving it to the MACs and a CMS webinar by J8 Tuesday said we have to use them now? They said it is ‘okay’ to use the 59 but optimal to begin using the x’s. There were several hospital based therapy callers on the line asking this question and that was there answer.

    1. We are aware of what WPS stated in a webinar and APTA has been notified. Just because WPS gave the answer they gave does not means it’s correct.

  4. Confirming that we are not to change our use of the 59 modifier at this time in private practice. Have been reading CMS MLN Natters and they say we are to begin use of XS, SU, XP and XE January 1st.

  5. Hi Have heard that there are new XE, XS, XP, XU modifiers, are they for outpatient PT? I think they misunderstood what they read.
    Please advise.

    Thank you

    1. Please see the current news section of my website for the most up-to-date information on the new subsets of modifier 59.

  6. Hospital Outpatient Therapy Depts are being told by our Compliance Officers to begin using new “X” modifiers in place of 59, as of jan 1, 2015.

    Do you have any 2015 updated information?