Jurisdiction M Part B - HCPCS Modifier XU (2024)

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FAQs

Jurisdiction M Part B - HCPCS Modifier XU? ›

HCPCS Modifier XU — unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service. HCPCS modifier XU indicates that a service is distinct because it does not overlap usual components of the main service.

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When would you use the Xu modifier? ›

You may report modifier 59 or XU for a diagnostic procedure performed before a therapeutic procedure only when the diagnostic procedure is the basis for performing the therapeutic procedure. View the Medicare Learning Network® Content Disclaimer and Department of Health & Human Services Disclosure.

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Can we use modifiers on HCPCS codes? ›

The HCPCS modifier –LT, for example, is regularly used in CPT codes when you need to describe a bilateral procedure that was only performed on one side of the body. HCPCS modifiers, like CPT modifiers, are always two characters, and are added to the end of a HCPCS or CPT code with a hyphen.

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How do you know when to use a modifier in CPT? ›

The most common examples of circ*mstances that require a modifier are:

A service or procedure has both a professional and technical component, but only one component is applicable.
A service or procedure was performed by more than one physician or in more than one location.

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Jan 10, 2022

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What modifier to use for multiple procedures? ›

Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session.

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In what cases must CPT modifiers be used? ›

CPT modifiers (also referred to as Level I modifiers) are used to supplement the information or adjust care descriptions to provide extra details concerning a procedure or service provided by a physician. Code modifiers help further describe a procedure code without changing its definition.

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What 2 types of modifiers may be used with anesthesia codes? ›

Here are the appropriate modifiers for anesthesia services:

AA (Anesthesia services performed personally by an anesthesiologist)
AD (Medical supervision by a physician: more than 4 concurrent anesthesia procedures)

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What is an invalid combination of HCPCS modifiers? ›

Remark code N519 indicates that the combination of HCPCS (Healthcare Common Procedure Coding System) modifiers submitted on the claim is not valid. This means that the modifiers used to provide additional information about the service or procedure billed do not work together according to billing guidelines.

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Where are the modifiers listed in HCPCS? ›

The HCPCS modifiers should be located in Appendix 2 (screenshot below). Depending on the publisher of each book, that appendix will be on different pages (you can find it by looking in your book's table of contents).

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Does Medicare accept modifiers? ›

Modifiers can be alphabetic, numeric or a combination of both, but will always be two digits for Medicare purposes.

What is an example of a Xu modifier? ›

Modifier XU

Use XU (“unusual non-overlapping service”) to indicate a service that is distinct because it does not overlap usual components of the main service. An example is performing a cardiac diagnostic test, and as a result of that test, performing a cardiac procedure later in the same day.

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What is the difference between CPT HCPCS code and modifiers? ›

A medical coding modifier is two characters (letters or numbers) appended to a CPT^® or HCPCS Level II code. The modifier provides additional information about the medical procedure, service, or supply involved without changing the meaning of the code.

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What are 59 modifiers? ›

For example, Modifier 59 should be used when coding for a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion (noncontiguous lesions in different anatomic regions of the same organ), or separate injury.

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What is the 50 modifier rule? ›

Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).

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Can a CPT have multiple modifiers? ›

Modifiers provide additional information to payers to make sure your provider gets paid correctly for services rendered. If appropriate, more than one modifier may be used with a single procedure code; however, are not applicable for every category of the CPT codes.

What is the modifier 52 rule? ›

These modifiers are used to report procedures that are discontinued by the physician due to unforeseen circ*mstances. Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia.

What modifier is used to identify surgical team? ›

The services of all physician members of a surgical team, including primary and assistant surgeons, must be billed on a single line of one claim for using the appropriate CPT code with modifier 66.

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Which modifier is used with anesthesia codes? ›

Every anesthesia procedure billed to OWCP must include one of the following anesthesia modifiers: AA, QY, QK, AD, QX or QZ.

What is the modifier for a repeat lab? ›

As a matter of differentiation, modifier 91, Repeat Clinical Diagnostic laboratory Test, is used when, in the course of treating a patient, it is necessary to repeat the same laboratory test on the same day to obtain subsequent test results.

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What is the GX modifier used for? ›

Modifier GX

The GX modifier is used to report that a voluntary Advance Beneficiary Notice of Noncoverage (ABN) has been issued to the beneficiary before/upon receipt of their DMEPOS item because the item was statutorily noncovered or does not meet the definition of a Medicare benefit.

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