Payers May Require DCs to Append New Subset Modifiers
Posted on Jan 19, 2015
|Payers May Require DCs to Append New Subset Modifiers|
|Thursday, January 15, 2015 12:32 PM|
On December 17th, ACA notified members concerning the new subset of HCPCS modifiers for modifier 59 that were proposed by CMS in August, 2014.
ACA has continued to monitor whether these modifiers will be required by commercial payers, and both United Healthcare and Anthem BCBS have released information as follows:
This time of year, payers will often post 2015 Policy Updates, Reimbursement Guidelines and Network Bulletins; for example some of the November and December Anthem Blue Cross and Blue Shield's newsletters stated that they would be implementing these modifiers. The aforementioned notice states otherwise. This illustrates the importance of checking payer websites weekly, if not daily. If such a notice is received, providers should ascertain whether the payer is requiring use with therapy services as some are selectively choosing the types of services to which this modifier subset will pertain. Meanwhile, providers are advised to continue using modifier 59 according to standard CPT directives.
ACA encourages you and your staff to stay alert to any information on this issue so that reimbursement will not be delayed for your practice. Be sure to only accept guidance from CMS, your MAC, and (if applicable) insurers on if/how/when to use these modifiers.