Modifier Codes XE, XP, XS, XU and 59
Effective January 1, 2015, HMSA will accept modifiers XE, XS, XP, and XU and recommends that providers use these modifiers in place of modifier 59 when appropriate.CMS created the new modifiers to be used to report greater specificity in situations where modifier 59 was previously reported. CMS refers to these modifiers as -X{EPSU}, which are more specific version of modifier 59.
- Modifier 59 should not be used when one of the -X{EPSU} modifiers describes the reason for the distinct procedural service.
- It is not appropriate to bill both modifier 59 and a -X{EPSU} modifier on the same line
NOTE: Per CPT Manual, modifier 59 should not be appended to an E/M service. This coding guideline also applies when billing -X{EPSU} modifiers.
Modifier Code XE
This modifier is used to identify "separate encounter, a service that is distinct because it occurred during a separate encounter".
Example
A physician performs a cardiovascular stress test and also performs and rhythm ECG at a different encounter from the cardiovascular stress test on the same day.
Modifier Code XP
This modifier is used to identify "separate practitioner, a service that is distinct because it was performed by a different practitioner".
Example
Two different physicians perform two separate procedures on a patient on the same day.
Modifier Code XS
This modifier is used to identify "separate structure, a service that is distinct because it was performed on a separate organ/structure".
Example
A physician performs two separate surgical services, destroy actinic keratosis on the face and biopsies a separate lesion on the trunk.
Modifier Code XU
This modifier is used to identify "unusual non-overlapping services, the use of a service that is distinct because it does not overlap usual components of the main service".
Example
A physician may perform a laparoscopy procedure on the liver and also does ultrasonic guidance unrelated to the laparoscopic liver procedure on the same day.
Modifier Code 59
HMSA will be following CMS guidelines for the use of modifier 59. This modifier is used to define a 'distinct procedural service' and will still be recognized.CPT instructions state that the -59 modifier should not be used when a more descriptive modifier is available.
The -X{EPSU} modifiers are more selective version of the -59 modifier and would be incorrect to include both modifiers on the same line.
Example
A physician may excise two suspicious breast lesions on the left breast on the same day. The physician would report modifier 59 to make it clear that the excision of two separate lesions on the same structure.
A physician may excise two suspicious breast lesions on the left and right breasts on the same day. Because the lesions were on separate breasts, the physician would report modifier XS to indicate that the second lesion was excised from a separate structure.
Sources:
CMS Transmittal 1422, Change Request 8863
MLN Matters MM8863
