The Centers for Medicare and Medicaid Services (CMS) has issued additional guidance regarding the new subsets of modifier 59 (i.e. XE, XP, XS, and XU) that became effective January 1, 2015 and the continued use of modifier 59 after January 1, 2015. In the updated guidance, CMS states providers may continue to use modifier 59 after January 1, 2015 in any instance in which it was correctly used prior to January 1, 2015. Additional guidance and education as to the appropriate use of the new modifiers will be forthcoming as CMS continues to introduce the modifiers in a gradual and

Cahaba Benefit Government Administrators, Medicare Administrative Contractor for the states of Alabama, Georgia, and Tennessee, has released their Medicare Physician Fee Schedule look-up tool for those 3 states. To access the tool, Gold Members log into your account and non-members become a Gold Member now. To access the look-up tool, click

Noridian Healthcare Solutions, Medicare Administrative Contractor for the states of Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming, has posted their Medicare Physician Fee Schedules for those states. To access the fee schedules, log into your Gold Member account or become a Gold Member now. To access the fee schedules, click  

Novitas Solutions has published their Medicare Physician Fee Schedule for the states in which they are the Medicare Administrative Contractor. States include Arkansas, Colorado, Delaware, Louisiana, Maryland, Mississippi,  New Jersey, New Mexico, Oklahoma, Pennsylvania, Texas as well as the District of Columbia. To access the fee schedule for your state, log into your Gold Member account or become a Gold Member.

Highmark Blue Shield will require therapy providers to append a new modifier to CPT codes for outpatient therapy services when those outpatient therapy services are for

National Government Services has released their 2015 Medicare Physician Fee Schedule (MPFS) for their states where they are the Medicare Administrative Contractor. States include Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, and Wisconsin. To access the MPFS, click{restrict paid=true] HERE.[/mepr-show]

For services reimbursed under the Medicare Physician Fee Schedule (MPFS), claims with dates of service on or after April 1, 2013 will continue to incur a 2% reduction in Medicare payment through March 31, 2015. I am often asked how the sequestration reduction impacts payment from the Medicare Administrative Contractor, how it impacts the calculation of the Medicare allowed amount that is applied to the annual therapy cap dollar threshold and how it impacts the Medicare patient’s financial responsibility in terms of co-insurance and/or deductible. To obtain the answers to above the questions, please log into your Gold Member account

Cigna Government Services, Medicare Administrative Contractor for the states of Kentucky and Ohio, has released their Medicare Physician Fee Schedule (MPFS) that is used to pay providers for outpatient therapy services. To access the MPFS and search payment for any CPT code, click