Example When to Use Modifier XP

March 23, 2015
Rick Gawenda

Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as a use to identify different encounters, different anatomic sites, and distinct services. Usage to identify a separate encounter is infrequent and usually correct; usage to define a separate anatomic site is less common and problematic; usage to define a distinct service is common and not infrequently overrides the edit in the exact circumstance for which the Centers for Medicare and Medicaid Services (CMS) created the edit in the first place. The CMS has implemented 4 new subsets of modifier 59 to combat the abuse of Modifier 59 and to better understand why providers utilize modifier 59. In this post, I will provide an example of when the XP modifier would be appropriate to use. The definition of Modifier XP is

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    1. please check out previous Current News stories on implementation date for the new subsets of Modifier 59.

  1. I went to Medicare seminar on March 10, 2015 and we discussed the subset modifiers. XP is used for separate practitioner performed by a different practitioner, same group only. XU is the unusual non-overlapping service which is the modifier 59.

    1. That is what this story states. Please re-read. Also, Medicare is the National program and they have not done any training on the new subsets of Modifier 59. Your Medicare contractor may have done something.

  2. If an O.T. bills for 97662 (Orthotics Eval) 97140, 97112 & 97110, what new subset modifier(s) should be used and appended to which of these 4 CPT codes?

    Thank you.

  3. I have OT charging 3 units 97112 and PT charging 4 units of 97112 on the same day. Should they both have 59 modifiers or should I use the XP now for this denial? OT had the 59 modifier but PT did not. Thanks.

    1. In your situation, modifier 59 and XP would not be applicable under Medicare. What payers pay for is payer specific and you would need to check with each insurance carrier.