Proper Use of Modifiers 59 & –X{EPSU}

This new Product comprises Subregulatory Guidance for proper use of modifiers 59 and –X{EPSU}, 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 https://www.cms.gov/files/document/chapter1generalcorrectcodingpoliciesfinal112021.pdf 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.

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