Modifier XP Fact Sheet

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
January 28th, 2015

Definition

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

Appropriate Usage

• Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
• Documentation indicates the services were provided by different practitioners in the same group practice
• Use Modifier XP with the Column 2 procedure code in the NCCI files
• Use Modifier XP only when there is no other modifier to describe the situation

Inappropriate Usage

• Code pairs are not part of the NCCI procedure to procedure edits
• If another valid modifier exists to identify the performance of the services by different practitioners
• Submission of E/M Codes
• Submission of Weekly radiation therapy management codes (CPT 77427)
• The NCCI code files show the modifier application as "0"
• Documentation does not support the services were provided by different practitioners
• Exact same procedure code performed twice on the same day
• Multiple administration of injections of the same drug
• Submitted with Modifier 59

Additional Information

• NCCI listings can be found on the CMS Website
• Medicare considers two physicians in the same group with the same specialty performing services on the same day the same physician.
• Providers should evaluate other modifiers such as the RT/LT identifying right and left, F1 - F0 to identify fingers, T1-T0 to identify toes and E1-E4 to identify eyelids. Evaluate additional modifiers to determine appropriate usage.

Modifier XP Fact Sheet

References:

• WPS - Government Health Administrators