Modifier XU Fact Sheet

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Jan 28th, 2015 - Reviewed/Updated Aug 8th

Definition

• Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service

Appropriate Usage

• Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
• Documentation indicates the service was not part of the usual components of the main service
• Use Modifier XU with the Column 2 procedure code in the NCCI files
• Use Modifier XU only when there is no other modifier to describe the situation

Inappropriate Usage

• Code pairs are not part of the NCCI procedure to procedure edits
• If another valid modifier exists to identify the service does not overlap the usual components of the main service - the column 1 procedure code
• Submission of E/M Codes
• Submission of Weekly radiation therapy management codes (CPT 77427)
• The NCCI code files show the modifier application as "0"
• Documentation supports the service is a component of the main service
• Exact same procedure code performed twice on the same day
• Multiple administration of injections of the same drug
• Submitted with Modifier 59

Additional Information

• NCCI listings can be found on the CMS Website
• Medicare considers two physicians in the same group with the same specialty performing services on the same day the same physician.
• Providers should evaluate other modifiers such as the RT/LT identifying right and left, F1 - F0 to identify fingers, T1-T0 to identify toes and E1-E4 to identify eyelids. Evaluate additional modifiers to determine appropriate usage.

Modifier XU Fact Sheet