Modifier XP Examples

November 16, 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 established 4 new subsets of modifier 59 to combat the abuse of Modifier 59 and to better understand why providers utilize modifier 59. The new subsets of modifier 59 became effective January 1, 2015 and providers can use them now instead of modifier 59; however, they are not mandated for use as of the posting of this article. In this article, I will provide examples of when the XP modifier would be appropriate to use. The definition of Modifier XP is Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner. The examples are as follows:

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  1. You state that the sub set became effective on January 1st, 2015 but were not mandated at the time the article was written. Are they still optional or are providers required to use the new subset now? Thank you for the information.

    1. As of January 21, 2016, the new subsets of modifier 59 are not mandated to be used for Medicare Part B beneficiaries receiving outpatient therapy services.