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 5 examples of when the XU modifier would be appropriate to use. The definition of Modifier XU is Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service. The examples are as follows:
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I’ve received denials when a patient has OT, PT, and ST on the same date. the denial code states “unbundled procedure”. Do I need to use the -59 modifier when same patient receives different modalities with same date of service?
If submitting all 3 disciplines on a UB-04 claim form, the insurance carrier may require modifier 59 depending on what CPT codes are billed on the same date of service.
Do we use the XE and XS codes for private insurances to let them know we are providing OT and ST on the same day? Also, can we both modifiers on a CPT to let the insurance know it was a separate encounter preformed by a different practitioner?
The new modifiers should not be used for private/commercial insurance carriers unless you know for sure they have implemented them and are using them instead of modifier 59. When applicable to use the new subsets of modifier 59, you would only use 1 modifier that is most applicable.