December 1, 2022
The following policies received an annual review with no changes:
- Modifier 33 – preventive services
- Modifier 59 – distinct procedural service
- Modifier 62 – two surgeons
- Modifier KX – requirements specified in the medical policy have been met
- Modifier NU – new durable medical equipment (DME) equipment and Modifier NR – new DME equipment when rented
- Modifier RR – durable medical equipment (DME) rental, Modifier KR – rental item-partial month and Modifier LL – lease/rental
- Modifiers XE, XS, XP and XU – separate encounter, separate structure, separate practitioner and unusual overlapping service
- Preadmission testing
The following November payment policies received their annual review with the noted changes:
- Services included in the global surgery payment section: Revised the first bullet and added the second bullet.
- Modifier 54 section: Added second bullet on the use of modifier 54 by emergency room providers who perform minor or major surgery in the ER.
- Modifier 57 section: Added clarification on the need for documentation in medical records to support decision for surgery.
- Modifier 24 section: Created new section for modifier 24. Added bullet points of examples when modifier should not be appended.
- Modifier 25 section: Created new section for modifier 25. Added clarification on when modifier 25 is valid. Added a paragraph from the modifier 25 policy indicating appending modifier 25 does not automatically allow for payment unless documentation supports a separate and distinct service.
- Modifier 58 section: Added a paragraph indicating that documentation in the medical record indicates plans to return patient to the operating room.
- Modifier 76 section: Created new section for modifier 76. Added reference that documentation supports the need to repeat the procedure.
- Modifier 77 section: Created new section for modifier 77.
- Modifier 79 section: Added a statement on the need for the documentation to support that the procedure is unrelated to the original surgery.
- Multiple Procedure Reduction section: Added a link to the Centers for Medicare & Medicaid Services (CMS) National Physician Fee Schedule.
Modifier RA – replacement of a DME, orthotic, or prosthetic item
- In the policy section, added two additional bullets for reasons for DME replacement.