Coding update modifiers: XE, XP, XS and XU for professional claims, effective January 1, 2015

Effective January 1, 2015, CMS is adding four new HCPCS modifiers to selectively identify subsets of modifier 59 for Distinct Procedural Services 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 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

Beginning with claims for dates of service on or after January 1, 2015, the Health Plan will accept these new modifiers, collectively referred to as -X{EPSU} modifiers. We will apply edits to the -X{EPSU} modifiers equivalent to our modifier 59 edits with our first quarter 2015 update scheduled for February 16, 2015. Prior to the February update, these modifiers will be considered informational and will not be used to override an edit when a modifier 59 override would be appropriate. Because these modifiers are more selective versions of modifier 59, they are not to be reported in conjunction with modifier 59. Modifier 59 will still be considered a valid modifier in the absence of a more descriptive modifier.