Podiatry Coding & Billing Alert

Question: Do all payers accept the X{EPSU} modifiers? One of my colleagues heard that you should only report them for Medicare Part B patients.

North Dakota Subscriber

Answer: The initial creation of the X{EPSU} modifiers in 2015 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}.

The “X 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).