Sorting out modifier -59 changes

Modifier -59 is not only the most used modifier, but it’s also one of the most abused. Modifier -59 is used to indicate that a procedure or service was distinct or independent from other non-E&M services performed on the same day. Modifier -59 might be used, for example, when allergy testing is performed on the same day as an allergy injection. It should not be confused with modifier -25 which is used when a procedure is performed on the same day as an E&M service.

Medicare (CMS) recently informed the Advocacy Council that, effective immediately, there will be four new modifiers from which allergists can choose if modifier -59 is rejected to further define “distinct procedural services.” These modifiers are referred to as the X-(EPSU) modifiers. The actual modifiers are titled XE, XP, XS, XU. Modifier -59 is not going away and will continue to be a valid modifier, according to Medicare. However, modifier -59 should NOT be used when a more descriptive modifier, like a XE, XP, XS or XU modifier, is available.

  • Modifier XE Separate encounter - A service that is distinct because it occurred during a separate encounter.
  • Modifier XP Separate practitioner - A service that is distinct because it was performed by a different practitioner.
  • Modifier XS Separate structure - A service that is distinct because it was performed on a separate organ/structure.
  • Modifier XU Unusual non-overlapping service - The use of a service that is distinct because it does not overlap usual components of the main service.

CMS is encouraging providers to adopt the modifiers quickly. Medicare contractors may, in their discretion, require use of the new edits even before national edits are in place. XS would seem to be the most appropriate of the X-EPSU modifiers to describe, for example, FeNO or spirometry (lung) done on the same visit as immunotherapy or testing for allergic rhinitis (nose) and could be used if modifier -59 is rejected. More information on the changes to modifier -59 can be found on the CMS website.

Advocacy Issue: 
Billing, Coding & Payments