APMA News - January/February 2021 - 24
X[E,S,P,U] MODIFIERS
AND MODIFIER -59:
WHAT'S ALL
THE FUSS
ABOUT?
By David Alper, DPM; David J. Freedman, DPM;
and Michael King, DPM
24 APMA News January/February 2021
T
he X[E,S,P,U] and 59 modifiers are represented by
two alpha and/or numeric characters that can be
appended to CPT® codes. When used, these modifiers provide more information about and clarification of the service represented by the CPT code to which
they are appended. The 59 modifier is a CPT modifier, created by the AMA CPT Editorial Panel. The X[E,S,P,U]
modifiers are HCPCS level-two modifiers, created by CMS.
On January 1, 2015, CMS established the X[E,S,P,U] modifiers as a subset to modifier 59. Of those four modifiers,
podiatrists most often have occasion to use modifier XS,
which represents a service that is distinct because it was
performed on a separate organ or structure, and modifier
XU, which represents an unusual non-overlapping service
that is distinct because it does not overlap with the usual
components of the main service.
The National Correct Coding Initiative (NCCI) oversees
bundling of codes and whether a procedure-to-procedure
edit can be bypassed with a modifier. Podiatrists have traditionally used the 59 modifier when appropriate to bypass a
procedure-to-procedure edit. However, since 2015, CMS
(and other payers more recently) has allowed bypassing of
procedure-to-procedure edits when appropriate with the
X[E,S,P,U] modifiers. According to CMS guidelines, modifier
59 should not be used when one of the X modifiers describes the
APMA News - January/February 2021
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APMA News - January/February 2021 - Contents
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APMA News - January/February 2021 - Cover3
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