Modifier 59 should only be reported when a procedure or service cannot be accurately reported with one of the more specific Modifiers: XE, XS, XP, or XU.
Use of Modifier 59 should be an infrequent occurrence. However, we continue to see a high use of Modifier 59 billing versus using the more descriptive modifiers as defined below:
- Modifier XE. Use for a service that is distinct because it occurred during a separate encounter.
- Modifier XS. Use for a service that is distinct because it was performed on a separate organ/structure.
- Modifier XP. Use for a service that is distinct because it was performed by a different practitioner .
- Modifier XU. Use for a service that is distinct because it does not overlap usual components of the main service.
The member's medical record must contain the supporting documentation for medical necessity that describes the circumstances precipitating the performance of the subsequent procedure or service.
Claims submitted with Modifiers 59, XE, XS, XP, or XU are subject to pre- and post-payment review and may be denied or retracted if used incorrectly. When requested by Independence Blue Cross or Independence Administrators, all supporting documentation must be provided. Failure to do so may result in denial of payment.
Learn more
Review the following Claim Payment Policies for more information on billing these Modifiers:
Note: The above policy links will expire and become unusable if an updated policy is issued.
To access the most updated version of any active policy, please refer to the Medical and Claim Payment Policy Portal or simply navigate to the Commercial or Medicare Advantage policy bulletins.
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