New PTP-Associated Modifiers

In a December 2014 Special Bulletin and the January 2015 monthly Medicaid Bulletin, it was announced that four new modifiers, developed to provide greater specificity in situations where modifier 59 was previously reported associated with procedure-to-procedure (PTP) editing, may be utilized in lieu of modifier 59 whenever possible.

Modifier 59 will remain a valid PTP-associated modifier. However, the coding instructions for modifier 59 specify that it should be used “only if no more descriptive modifier is available�. Therefore, providers should use one of the new modifiers, instead of modifier 59, if the clinical situation described by one of the new modifiers is present.

This change was made based on guidance from the Centers for Medicare and Medicaid Services (CMS), as part of the National Correct Coding Initiative. As of May 3, these new modifiers are now active in NCTracks for claims with dates of service on or after January 1, 2015.

Claims already submitted with modifier 59 require no further action. If a provider submitted a claim using one of the new modifiers prior to May 3 and received a denial, they can resubmit the claim.

For further information regarding the new modifiers and their usage, see the full bulletin articles below: