Tuesday, October 27, 2015

When to use XE, XP, XS, XU modifiers ?

The Centers for Medicare and Medicaid Services (CMS) has created four new healthcare common procedure coding system (HCPCS) modifiers to selectively identify subsets of modifier 59 (distinct procedural services) for use, effective Jan. 1, 2015. They are:

• XE Separate Encounter: A service that is distinct because it occurred during a separate encounter.

• XP Separate Practitioner: A service that is distinct because it was performed by a different physician.

• XS Separate Structure: A service that is distinct because it was performed on a separate organ/structure.

• XU Unusual Non-Overlapping Service: A service that is distinct because it does not overlap usual components of the main service.

These modifiers, collectively referred to as X {EPSU} modifiers, define specific subsets of modifier 59. Like CMS, UnitedHealthcare will continue to recognize modifier
59; however, current procedural terminology (CPT) instructions state that modifier 59 should not be used when a more descriptive modifier is available. In addition, the X {EPSU} modifiers are more selective versions of modifier 59 so it would be incorrect to include both modifiers on the same line.


CMS will continue to recognize modifier 59 but may selectively require a more specific X {EPSU} modifier for billing certain codes at high risk for incorrect billing. For example, a particular national correct coding initiative (NCCI) procedure to procedure code pair edit may be identified as payable only with the XE separate encounter modifier but not the 59 or other X {EPSU} modifiers.

UnitedHealthcare will recognize these new modifiers, effective for dates of service on and after Jan. 1, 2015. Please reference the following table to find out when the new modifiers will be considered in administering the UnitedHealthcare’s reimbursement policies. New “X” Modifiers and Impact to UnitedHealthcare Commercial Reimbursement Policies


Policy   X{EPSU} Modifiers considered in lieu of Modifier 59    Effective for claims with dates of service Jan. 1, 2015 processed on or after these dates:

Anesthesia XE and XU Feb. 15, 2015
Bilateral XS Jan. 1, 2015
CCI Editing XE, XP, XS, and XU Jan. 1, 2015
Laboratory Services
XE, XP, XS, and XU Feb. 15, 2015
Maximum Frequency Per Day XE, XS, and XU Jan. 1, 2015
Obstetrical XE, XS, and XU Feb. 15, 2015
Pediatric and Neonatal Critical & Intensive Care Services XE, XS and XU New policy becomes effective March 1, 2015 DOS
Procedure to Modifier XE, XP, XS, and XU Feb. 15, 2015
Professional-Technical Component XE, XP, XS, and XU Feb. 15, 2015
Radiology Multiple Imaging Reduction XE Jan. 1, 2015
Rebundling XE, XP, XS, and XU Feb. 15, 2015

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