Medicare X Modifiers: Use or not Use?

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September 15, 2016

Question:
What’s new with the X modifiers established by Medicare? Should we be using them now?

Answer:
As of July 7, 2016, Medicare has yet to finalize a formal policy for the use of the X modifiers as a replacement to the 59 modifier. The X modifiers are shown below.

  • XE: Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter
  • XS: Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure
  • XP: Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner
  • XU: Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service

At this point, Medicare has given practices the option to use the X modifier or the 59 modifier. Some of our clients tell us that they are using the X modifiers without any payment issues. Be assured that eventually the X modifier will become standard Medicare policy since the intent of these modifiers is to force providers to be more specific regarding the rationale for unbundling two bundled CPT codes. Medicare developed these modifiers to reduce misuse and abuse of the 59 modifier.

*This response is based on the best information available as of 09/15/16.

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