X{EPSU} Modifiers
Effective Jan. 1, 2015, the Centers for Medicare & Medicaid Services (CMS) implemented four new modifiers to define specific subsets of the 59 modifier. These new modifiers are referred to as X{EPSU} modifiers, and are more selective versions of modifier 59.
Current procedural terminology (CPT) instructions state that modifier 59 should not be used when a more descriptive modifier is available.
X{EPSU} modifiers are as follows:
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.
The choice of modifier depends on the circumstances in which the services were performed, and whether or not the payer has implemented the X{EPSU} modifiers.
Many payers will continue to recognize modifier 59 but may selectively require the more specific X {EPSU} modifier for billing certain situations.
For instance, if 76816 is performed by one provider in the practice, and 76818 is done by another provider, modifier XP would be most appropriate:
Physician A: 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (e.g., re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, or re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus
Physician B: 76818-XP Fetal Biophysical Profile with non-stress testing
Another example is fetal echocardiography done on twins. In this case, each fetal cardiovascular system is a separate structure. Thus, modifier XS is more specific than modifier 59 in describing the circumstances:
Twin 1: 76825 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M mode recording
Twin 2: 76825-XS Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M mode recording
It is important to check payer policies, and to stay updated on insurers who are recognizing these new modifiers.
Note: It would be incorrect to include both modifier 59, and an X{EPSU} modifier on the same line, as the X{EPSU} modifiers are a subset of modifier 59.