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MLN Product (Revised); Title: Proper Use of Modifiers 59 and –X{EPSU}

This revised Product comprises Subregulatory Guidance for proper use of modifiers 59, XE, XP, XS, and XU and its content is based on publically available content in Chapter 1 of the General Correct Coding Policies for National Correct Coding Initiative Policy Manual for Medicare Services within CMS policy or operation subject matter experts also reviewed/cleared this product. This product educates physicians and other providers on the definition of modifiers 59, XE, XP, XS, and XU; appropriate and inappropriate use of these modifiers; and gives examples of appropriate and inappropriate use. The Medicare National Correct Coding Initiative (NCCI) includes Procedure-to-Procedure (PTP) edits that define when certain Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) codes shouldn’t be reported together. The purpose of these edits is to prevent payment for codes that report overlapping services except where the services are “separate and distinct”. Modifier 59 is used to identify procedures/services, other than Evaluation/Management services, that are not normally reported together, but are appropriate under the circumstances. XE, XS, XP, and XU are valid modifiers and provide greater reporting specificity.
Revisions to this product didn’t include any substantive content updates. The previous version of this Product is available to the public and currently posted on the CMS website at: .

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Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: March 29, 2023

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.