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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.

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