Outpatient Facility Coding Alert

Question: Which payers accept the X{EPSU} modifiers? I’ve heard that you should only report them for Medicare Part B patients.

Utah 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, most billing practices (of various specialties) 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 practice guidelines so all current and future coders are aware that the respective insurance companies do not allow modifiers X{EPSU}.

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