Continued Use of Modifier 59 after January 1, 2015

CMS established four (4) new HCPCS modifiers (XE, XP, XS, XU) to define specific subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service”. Providers may continue to use the -59 modifier after January 1, 2015, in any instance in which it was correctly used prior to January 1, 2015. Additional guidance and education as to the appropriate use of the new –X {EPSU} modifiers will be forthcoming as CMS continues to introduce the modifiers in a gradual and controlled fashion. CMS will identify situations in which a specific –X {EPSU} modifier will be required and will publish specific guidance before implementing edits or audits. Providers who wish to use the new modifiers may use them in accordance with their published definitions, and the X modifiers will function within CMS systems in the same manner as the 59 modifier, bypassing Procedure-to-Procedure (PTP) edits with a modifier indicator of “1,” for example. A modifier indicator of “1” indicates that NCCI-associated modifiers may be used to bypass an edit under appropriate circumstances.