2025 HCPCS code XS
(Active) Effective Date: N/A Modifiers for HCPCS codes - Modifiers Feed
Separate structure, a service that is distinct because it was performed on a separate organ/structure.
Modifier XS is used specifically to indicate distinct procedures on separate structures. It cannot be used with modifier 59. Other anatomical modifiers (RT/LT, etc.) might be appropriate depending on the specific procedures.
Medical necessity for using modifier XS must be supported by documentation demonstrating that the distinct procedures performed on separate organs/structures during the same encounter were medically necessary and not routinely performed together.
The physician is responsible for documenting the medical necessity of performing distinct procedures on separate organs/structures during the same encounter and ensuring appropriate modifier usage.
In simple words: Modifier XS is used when a doctor performs procedures on separate organs or body parts during the same visit.It helps ensure correct billing when two procedures aren't typically done together but are medically necessary.
Modifier XS identifies a distinct procedural service performed on a separate organ or structure during the same encounter. It provides higher specificity than modifier 59 and is used to bypass National Correct Coding Initiative (NCCI) edits when services are performed on different organs or structures. Use modifier XS with the column 2 procedure code in the NCCI files. It should not be used with modifier 59 on the same line item, and documentation must support the services being performed on separate organs/structures.
Example 1: A patient undergoes a laparoscopic cholecystectomy (gallbladder removal) and a separate laparoscopic appendectomy (appendix removal) during the same operative session. Modifier XS would be appended to the appendectomy code., A cardiologist performs a diagnostic cardiac catheterization of the left heart and then performs a separate diagnostic cardiac catheterization of the right heart. Modifier XS would be appended to the code for the right heart catheterization., A surgeon performs a repair of an inguinal hernia on the left side and then performs a separate repair of an inguinal hernia on the right side. Modifier XS would be appended to the code for the right side hernia repair.
Documentation must clearly support the medical necessity of distinct procedures performed on separate organs or structures during the same encounter. The operative report or procedure note should detail the separate procedures and anatomical locations.
- Specialties:Modifier XS can be used across various surgical and medical specialties where procedures are performed on separate organs or structures, including but not limited to: General Surgery, Cardiovascular, Orthopedic, and Urology.
- Place of Service:Various places of service, including: "Inpatient Hospital", "Ambulatory Surgical Center", "Office".