ED Coding and Reimbursement Alert

Question: Which payers accept the X{EPSU} modifiers? We’ve had very little success with them.

Codify Subscriber

Answer: The initial creation of the X{EPSU} modifiers did not provide much clarity as to whether coders should exclusively report them for Medicare Part B patients, or if other payers would accept them as well. However, many EDs have found in the years following that many payers do, in fact, allow for X{EPSU} modifiers to be appended to their claims. In order to streamline this process in the future, you should make sure to keep a log of any payers that do not accept modifiers X{EPSU} in place of modifier 59 (Distinct procedural service). Denying payers should be documented in your ED practice guidelines so all current and future coders are aware that the respective insurance companies do not allow modifiers X{EPSU}.

The “X modifiers” were developed in 2015 to provide greater reporting specificity in situations where modifier 59 was previously reported. The modifiers are defined as follows:

• XE (Separate encounter on the same date of service)
• XS (Separate structure)
• XP (Separate practitioner)
• XU (Unusual non-overlapping service, or one that does not overlap with the usual components of the main service).