Institute of Good Manufacturing Practices India®

MCS claim processing system logic modifications: Modifier 59, XE, XS, XP, and XU (MM11168)

The changes in MM11168 became effective since 01 July 2019. This change is applicable for suppliers, providers, physicians who are involved in claim submission to Medicare Administrative Contractors to avail Medicare beneficiaries.

Modifications have been done in the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) edits containing one and two column codes. The billing staff must be aware about these variations to ensure smooth functioning.

The NCCI-associated modifiers involved in recent modifications are Modifiers 59, XE, XS, XP, and XU. At present, the Multi-carrier system (MCS) needs working on column two code of PTP edit for edit bypass. With CR11168 implementation, column one and two code will be done for edit bypass.