2025 HCPCS code XP
(Active) Effective Date: N/A Modifiers - Modifiers for HCPCS codes Feed
Separate practitioner, a service that is distinct because it was performed by a different practitioner.
Modifier XP is itself a modifier and therefore other modifiers would not generally be applied to it directly. However, other modifiers may be applicable to the procedure code to which XP is appended, depending on the circumstances.
The medical necessity of each distinct procedure or service must be individually documented.The fact that two services were performed on the same day by different practitioners doesn't negate the need for independent medical necessity justification for each service.The documentation should explain why each procedure or service was medically necessary for the patient's condition.
The clinical responsibility for the services billed with modifier XP lies with the individual practitioner who performed the distinct procedure or service.Each practitioner is responsible for documenting the medical necessity and appropriateness of the care they provided.Clear documentation of each separate service is essential for accurate billing and reimbursement.
In simple words: If you see two different healthcare providers on the same day and they perform separate procedures, the bill might use the code XP. This code shows that the procedures, while done on the same day, were performed by different providers and shouldn't be combined as one single service.
Modifier XP identifies a distinct procedure/service performed by a different practitioner on the same patient on the same day.It is a subset of modifier 59 (Distinct Procedural Service) and provides greater specificity. Modifier XP should not be used with evaluation and management (E/M) services or appended with modifier 59 on the same line.Documentation must support its use.
Example 1: Scenario 1: A patient undergoes a cardiovascular stress test performed by a cardiologist and is then referred to a separate provider for a rhythm ECG on the same day.Modifier XP would be appended to the rhythm ECG CPT code., Scenario 2: A patient sees an orthopedic surgeon for knee pain and the surgeon orders an X-ray. The X-ray is performed and interpreted by a radiologist on the same day. Modifier XP could be used on the code for the X-ray interpretation., Scenario 3: A patient has a lesion removed by a dermatologist and on the same day receives an unrelated vaccination administered by a nurse practitioner.Modifier XP would be appended to the vaccination administration code.
Documentation should clearly support the distinct and separate nature of the services provided by different practitioners.The medical record must justify the medical necessity of each procedure/service. It should also indicate the identity of each practitioner who performed a service/procedure, including their credentials.If modifier XP is used to bypass an NCCI edit, the documentation must substantiate the reason for the bypass.
- Payment Status: Active
- Modifier TC rule: Modifier TC does not apply to modifier XP. The TC modifier designates the technical component of a procedure, whereas XP is a modifier to describe a distinct service provided by a different practitioner.
- Specialties:Modifier XP can be used across many specialties whenever distinct services are performed on the same day by different practitioners. This might include situations involving specialists like cardiologists, radiologists, orthopedists, dermatologists, and other specialists working in conjunction with other providers.
- Place of Service:Modifier XP can be applicable to various places of service, including "Inpatient Hospital", "Office", "Outpatient Hospital", and more, as long as the criteria for its use are met – that is, a distinct procedure performed by a different practitioner on the same day.