As we previously reported, four new HCPCS modifiers that define specific subsets of the -59 modifier went into effect January 1, 2015. These new HCPCS modifiers — -XE, -XP, -XS, -XU — are referred to collectively as -X{EPSU} modifiers.

The Centers for Medicare & Medicaid Services (CMS) has published a new MLN Matters Article (SE1503) designed to provide education on continued use of the -X {EPSU} modifiers, and more specifically to remind providers that they may continue using the -59 modifier after January 1, 2015, in any instance in which it was correctly used prior to January 1, 2015.

In SE1503, CMS states the following:

CMS implemented Change Request (CR) 8863 on January 5, 2015, effective January 1, 2015. This CR established four new HCPCS modifiers (XE, XP, XS, XU) to define specific subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.” These modifiers are collectively referred to as -X {EPSU} modifiers.

Please note that providers may continue to use the -59 modifier after January 1, 2015, in any instance in which it was correctly used prior to January 1, 2015. The initial CR establishing the modifiers was designed to inform system developers that healthcare systems would need to accommodate the new modifiers. Additional guidance and education as to the appropriate use of the new -X {EPSU} modifiers will be forthcoming as CMS continues to introduce the modifiers in a gradual and controlled fashion. That guidance will include additional descriptive information about the new modifiers. CMS will identify situations in which a specific -X {EPSU} modifier will be required and will publish specific guidance before implementing edits or audits.

CR 8863 states that providers who wish to use the new modifiers may use them in accordance with their published definitions, and the X modifiers will function within CMS systems in the same manner as the 59 modifier, bypassing Procedure-to-Procedure edits with a modifier indicator of “1,” for example. A modifier indicator of “1” indicates that NCCI-associated modifiers may be used to bypass an edit under appropriate circumstances.

View SE1503 on continued use of modifier 59 (pdf).