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The Centers for Medicare and Medicaid Services establishes new procedure-to-procedure associated modifiers

The Centers for Medicare and Medicaid Services establishes new procedure-to-procedure associated modifiers

Four new HCPCS modifiers are being established for claims with dates of service on or after 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 practitioner
  • XS Separate structure: a service that is distinct because it was performed on a separate organ / structure
  • XU Unusual non-overlapping service: the use of a service that is distinct because it does not overlap usual components of the main service

These modifiers may be used for clinical situations in which two Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes are reported by the same provider on the same date of service and that are currently indicated by appending modifier 59 – “Distinct Procedural Service” to a HCPCS/CPT code.

Modifier 59 is one of a number of modifiers designated as Medicaid National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP)-associated modifiers. When an NCCI PTP-associated modifier is appropriately appended to one of the codes in a PTP edit pair that has a Correct Coding Modifier Indicator (CCMI) of “1”, the edit is bypassed. Information about PTP-associated modifiers in general and modifier 59 in particular can be found in the Medicaid NCCI Policy Manual (rev. 11/14), which is posted on the Medicaid NCCI website:

The information is located in Chapter 1 beginning on page I-20. Additional information about modifier 59 can also be found in a separate Modifier 59 Article (rev. 10/14) that is also posted on the Medicaid NCCI website. The general principles described in the modifier 59 article apply to the new X{EPSU} modifiers.

Modifier 59 will remain a valid PTP-associated modifier. Use of the new X{EPSU} modifiers is currently optional. However, providers may choose to use them to specify more clearly the clinical situations in which modifier 59 is now reported.