Is Modifier -59 going away?

November 5th, 2014

Anyone who uses modifier 59 needs to be aware that due to problems with the incorrect usage of this modifier (which by the way is also revised for 2015,) CMS has added four new HCPCS modifiers. An announcement by CMS stated that "CMS is establishing four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.”

These new codes are:

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

"CMS will continue to recognize the -59 modifier, but notes that Current Procedural Terminology (CPT) instructions state that the -59 modifier should not be used when a more descriptive modifier is available."

These codes will replace the use of modifier 59 where applicable. Providers and coders need to ensure that patient documentation appropriately identifies the rationale for code selection.

It should be noted that CMS recognizes that modifier 59 has the potential for abuse and will be requiring the use of these new modifiers in January. For this reason, it is highly likely that claims reported with modifier 59 will be closely scrutinized. Be sure that all staff are aware of and understand the proper use of these new codes.

Because other payers often follow CMS policies, watch for announcements by other payers regarding the use of these new modifiers. 

The complete announcement by CMS includes a more detailed discussion regarding the improper use of this modifier. See the article referenced below to review the complete announcement.


Is Modifier -59 going away?. (2014, November 5). Find-A-Code Articles. Retrieved from

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)

Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
free demo
request yours today
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.