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Reimbursement Issues Related to Modifiers 59, XE, XS, XP, and XU

Topic: Modifier 59

Sponsor: Corcoran Consulting Group

Updated: 01/01/2022

Corcoran Consulting Group

CPT defines modifier 59 as a “Distinct Procedural Service”.  CPT explains:  “Modifier 59 is used to identify procedures or services, other than E/M services, that are not normally reported together but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual.”

This FAQ addresses the following:

  1. How is modifier 59 defined in CPT?
  2. Are there any concerns with modifier 59?
  3. May modifier 59 be used to override the NCCI edits if each procedure has a distinct indication and is preplanned?
  4. Are different areas of the same retina (e.g., macula and peripheral retina) considered different anatomic sites?
  5. What are the X{EPSU} modifiers?
  6. When is modifier XE used?
  7. When is modifier XS used?
  8. When is modifier XP used?
  9. What is modifier XU, and when might it be used?