Harvard Pilgrim Health Care Home
  Learn more.
  Sign up for HPHConnect.
Medical Management
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Office Support
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

February 2015

Update to CPT and HCPCS Level II Modifiers Payment Policy

In January, the Centers for Medicare and Medicaid Services (CMS) introduced 4 HCPCS modifiers, known collectively as the X{EPSU} modifiers, as a subset of modifier 59 to allow for more precise coding options and reduce errors in the use of modifier 59. Modifier 59 is used to denote a distinct procedural service — a service that is separate and distinct from another service with which it is normally bundled.

Harvard Pilgrim is now accepting the following X{EPSU} modifiers and has updated our CPT and HCPCS Level II Modifiers Payment Policy to include them for use in noting a distinct procedural service:

  • XE-Separate Encounter
  • XP-Separate Practitioner
  • XS-Separate Organ/Structure
  • XU-Unusual Separate Service

Consistent with CMS’ guidelines, avoid using modifier 59 if a more descriptive modifier is appropriate. Harvard Pilgrim validates the appropriate use of these modifiers. When submitting a claim with these modifiers, you must also submit operative/medical notes for review. For more complete information, please refer to the CPT and HCPCS Level II Modifiers Payment Policy in our online Provider Manual.

Email this article to a colleague   

Network Matters Archives

Download printer-friendly version


Reminder: CAQH Switching to New Version February 24-March 2

Data Sharing Enhancements


Coverage of New Hepatitis C Medication Harvoni

Fentanyl Patch and Xartemis XR Quantity Limit

Granix Now Covered Under Pharmacy Benefit

Prior Authorization Required for Afrezza

Prior Authorization Required for Otezla

Tier Increase for Rebif on Premium Formularies

Caring for a Caregiver: Signs and Treatment of Caregiver Stress


Update to CPT and HCPCS Level II Modifiers Payment Policy

Urgent Care Network Requirements


Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator