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As a reminder, effective January 1, 2015, providers should be reporting
services that are separate, distinct, or independent from other non-evaluation
and management (E&M) services and performed on the same day with the following
codes:
- Modifier XE: Separate Encounter
- Modifier XP: Separate Practitioner
- Modifier XS: Separate Structure
- Modifier XU: Unusual Non-Overlapping Service
- Modifier 59: Distinct Procedural Service (only to be used when the service
cannot be more accurately reported with one of the four ?X{EPSU} modifiers
listed above)
For guidelines on how to report these modifiers, including appropriate and
inappropriate uses, refer to the following claim payment policies:
- Commercial: #03.00.08d: Modifiers XE, XS, XP, XU, 59 (previously
Modifier 59: Distinct Procedural Service)
- Medicare Advantage: #MA03.005a: Modifiers XE, XS, XP, XU, 59
(previously Modifier 59: Distinct Procedural Service)
Providers should use the more specific ?X{EPSU} modifiers to accurately
represent the circumstances that render non-E&M services as separate, distinct,
or independent. However, modifier 59 can still be reported if the service
cannot be more accurately reported with one of the four specific modifiers.
Providers cannot append more than one of these modifiers (i.e., XE, XP, XS, XU,
or 59) to a single procedure code. Claims submitted with any of these modifiers
may be subject to retrospective review and audit if it is determined that
providers are not using them in accordance with the billing requirements in our
claim payment policies.
For more information on the use of modifier 59 and the ?X{EPSU} modifiers,
go to our Medical Policy Portal and select Accept and Go to
Medical Policy Online. Then select either the Commercial or
Medicare Advantage tab, depending on the version of the policy you'd
like to view, and type in the policy name or number in the Search field.
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