Modifier XS or 59 on G0444

[KoBee]

We are seeing providers billing the following on the same date of service:

• G0439 (AWV)
• Problem E/M (99212–99215)
• G0444 (Depression screening)

As expected, there is an NCCI edit where G0444 bundles into the E/M service. I’ve seen varying guidance where organizations report using modifiers such as 59 or the X modifiers (XS/XU) to allow payment when appropriate.

We are in the process of trying to build automated system logic and want to ensure we are applying the correct modifier for Medicare and Medicare Advantage payers when appropriate.

My questions:​

• For Medicare, is it appropriate to use:
  • Modifier 59, or
  • One of the X modifiers (XS vs XU)?
• Has anyone successfully implemented logic for this combination, and if so, how are you applying it?
• Or are you not applying any modifier to G0444 and instead relying on documentation/supporting medical necessity?

Would appreciate any insight or best practices others are using before we move forward with a build.

Thank you in advance!

 

[rthomas@impcna.com]

We are seeing providers billing the following on the same date of service:

• G0439 (AWV)
• Problem E/M (99212–99215)
• G0444 (Depression screening)

As expected, there is an NCCI edit where G0444 bundles into the E/M service. I’ve seen varying guidance where organizations report using modifiers such as 59 or the X modifiers (XS/XU) to allow payment when appropriate.

We are in the process of trying to build automated system logic and want to ensure we are applying the correct modifier for Medicare and Medicare Advantage payers when appropriate.

My questions:​

• For Medicare, is it appropriate to use:
  • Modifier 59, or
  • One of the X modifiers (XS vs XU)?
• Has anyone successfully implemented logic for this combination, and if so, how are you applying it?
• Or are you not applying any modifier to G0444 and instead relying on documentation/supporting medical necessity?

Would appreciate any insight or best practices others are using before we move forward with a build.

Thank you in advance!

We use the XU modifier on G0444 for Medicare and Medicare Advantage plans. We have never had a problem with reimbursement or rejections. If you use EPIC you could have logic created in charge review to have a warning say possible modifier XU needed for whenever G0444 is charged with G0402, G0438 or G0439.