July 21, 2016

Question:
What’s new with the X modifiers established by Medicare? Should we be using them now?

Answer:
As of today, Medicare has yet to finalize a formal policy for the use of the -X{EPSU} modifiers as a replacement for modifier 59. The -X{EPSU} modifiers are shown below but have not yet been well defined by Medicare.

• XE: Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter

• XS: Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure

• XP: Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner

• XU: Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service

At this point, Medicare has given practices the option to use the -X{EPSU} modifiers or the 59 modifier. Some of our clients tell us that they are using the -X{EPSU} modifiers without any payment issues. We suspect that the -X{EPSU} modifiers will eventually become standard Medicare policy since the intent of these modifiers is to force providers be more specific regarding the rationale for unbundling two bundled CPT codes. Medicare developed these modifiers to reduce misuse and abuse of modifier 59.

Remember, Medicare prefers reporting multiple units of add-on codes by indicating the number in the units box. For example, report +13133 x 2 units (not 13133, 13133-59). The point is to reduce the utilization of modifier 59.

*This response is based on the best information available as of 07/21/16.