Wiki MODIFIER 59 OR XP

[cherylbr]

When billing for Medicare and CMS claims we are currenly using modifier XP.

When billing commercial carrier claims we are not sure if they require the 59 or XP.

Does anyone have any idea where I might find the correct way to bill this?

Thank you,
Cheryl

 

[Orthocoderpgu]

The X modifiers were created by CMS to give them more specific information why procedures don't bundle such as a different provider, anatomical structure/surgical approach and so forth. So for CMS you would always use the X modifiers. I would use -59 for commercial as a general rule. Some commercial payers may process claims with the X modifiers, but I would use modifier -59 first. Let's hope that someone can respond with a list of any commercial that does process with the X modifiers.

 

[cherylbr]

The X modifiers were created by CMS to give them more specific information why procedures don't bundle such as a different provider, anatomical structure/surgical approach and so forth. So for CMS you would always use the X modifiers. I would use -59 for commercial as a general rule. Some commercial payers may process claims with the X modifiers, but I would use modifier -59 first. Let's hope that someone can respond with a list of any commercial that does process with the X modifier

Thank you very much for your response. Now its just a matter of knowing which commercial carriers don't recognize the XP.

 

[trarut]

Check your major payer's reimbursement policies. Most of them have a modifier policy or will have a bundling policy that outlines what modifiers they accept.

 

[csperoni]

Almost all of our commercial carrier contracts have wording that Medicare coding will be followed. We use -XU, -XP or -XS for commercial carriers and I don't recall ever seeing a denial.