Examples of When to Use Modifier XU

April 6, 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 5 examples of when the XU modifier would be appropriate to use. The definition of Modifier XU is

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    1. CMS has not announced the implementation date for the new modifiers for outpatient therapy services.

  1. Can you clarify – when is it mandatory to begin using the new X modifiers to replace -59 when appropriate on outpatient therapy claims? I know the CMS transmittal was Jan 2015 but I understood there was a hold for outpatient therapy but now cannot locate timelines?

    1. as of June 23, 2015, CMS has not transitioned to the new subsets of modifier 59 for outpatient therapy services.

    1. CMS will provide notice when they will transition to the new subsets of modifier 59 for outpatient therapy services.

    2. CMS will provide further guidance when they will implement the new subsets of modifier for outpatient therapy services. Until that time, keep using modifier 59 when required for outpatient therapy services.

    1. As of September 28, 2015, CMS still allows the use of Modifier 59. The new subsets of modifier can also be used in place of modifier 59 if you choose with the Medicare program.