With the implementation of the new subsets of modifier -59, Distinct Procedural Service, the Central Office on HCPCS has received numerous questions regarding how to apply the new X modifiers.
According to the Centers for Medicare & Medicaid Services (CMS) the new subsets (i.e., XE, XS, XP, and XU) of modifier -59 have been acceptable for reporting purposes since January 1, 2015. These modifiers are defined as:
• 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
CMS previously stated that facilities could report either modifier -59 or the more selective modifiers XE, XP, XS or XU.
On recent clarification from CMS, facilities should continue reporting with modifier -59 only, until specific instructions regarding the use of the new subsets of modifier -59 are published by CMS.
Please note that if your facility decides to continue utilizing the new subset modifiers, these new subset modifiers will be treated the same as modifier 59 until further guidance is provided.
Do the four new X modifiers apply only for Medicare reporting and Modifier -59 only for reporting to other payers?
The new X modifiers are Medicare modifiers. However, other payers are not prohibited from the use of these new X modifiers.