Are CMS and Other Payers Requiring –X{EPSU} Modifiers?

Commonly Asked Coding Questions – September 2016
by Sarah Wiskerchen, MBA, CPC 

Q: Are the Centers for Medicare & Medicaid Services (CMS) and other payers requiring use of –X{EPSU} modifiers?

A: Although the four –X{EPSU} modifiers were initiated by CMS, they have also been part of the Common Procedural Terminology (CPT) manual since 2015. These four modifiers—XE, XS, XP, and XU—are used in lieu of modifier 59. The modifiers are commonly called –X{EPSU} modifiers for separate Encounter, Structure, Practitioner, and Unusual non-overlapping service referenced in the EPSU acronym.

The latest CMS directives about using the –X{EPSU} modifiers were issued last year (2015). According to MedLearn Matters (Jan. 1, 2015), SE1503, providers could continue to use modifier 59 after Jan. 1, 2015, “in any instance in which it was correctly used prior to Jan. 1, 2015.” CMS also promised additional guidance and education on the appropriate use of the new –X{EPSU} modifiers.

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