New NCCI Modifiers

Effective for dates of service on and after January 1, 2015, four new HCPCS modifiers will be established that should be added to the list of Procedure-to-Procedure (PTP) – Associated Modifiers for Medicaid claims, which are listed below:

• 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 describe clinical situations that currently are indicated by appending modifier 59 – “Distinct Procedural Service”.  The new modifiers were established so that providers could specify more clearly the situations in which PTP edits may be eligible to be bypassed. Therefore, providers should use one of the new modifiers, instead of modifier 59, if the clinical situation described by one of the new modifiers is present.  Please be reminded that Arkansas Medicaid is not allowed to publish the procedure codes to be placed on NCCI edits.