2025 HCPCS code XU
(Active) Effective Date: N/A Unusual non-overlapping service - Modifiers for HCPCS codes Feed
Indicates a service distinct due to non-overlap with usual components of the main service.
Modifier XU cannot be used in conjunction with modifier 59 on the same line item. It replaces modifier 59 in situations where it provides a more specific description of the service.
Medical necessity for both the main service and the service with modifier XU must be independently established and documented. The unusual, non-overlapping nature of the service with modifier XU itself doesn't justify medical necessity.Specific payer guidelines may apply.
The physician is responsible for appropriately appending modifier XU to ensure accurate billing when an unusual, non-overlapping service is provided in addition to the main service. This requires clear documentation in the patient's medical record justifying the use of the modifier.
In simple words: Modifier XU is used when a doctor performs an unusual service during the same visit as another, more common, service.The unusual service is separate and not typically part of the common service, ensuring proper billing for both.
Modifier XU, "Unusual Non-Overlapping Service," signifies a distinct service performed that doesn't overlap with the typical components of the primary service provided to a patient. It acts as a more specific alternative to modifier 59 and helps avoid incorrect billing practices. While the system allows reporting multiple lines with both modifiers 59 and XU, it aggregates them during processing. Modifier XU should not be used with evaluation and management (E/M) codes.
Example 1: A patient undergoes a cardiac diagnostic test, which reveals a need for a cardiac procedure later the same day. The diagnostic test and the subsequent procedure are distinct and can be billed separately using modifier XU on the procedure code., After completing a therapeutic procedure, a physician performs a diagnostic procedure. If this diagnostic procedure is not a standard follow-up to the therapeutic one, modifier XU can be used., A patient receives an injection in a joint for pain relief. On the same day, but as a separate and distinct service, the same physician performs a minor surgical procedure on the skin near the injection site. This surgical procedure could be coded with modifier XU because it's unusual and doesn't overlap with the joint injection.
The patient's medical record must contain documentation that supports the use of modifier XU. This documentation should clearly explain why the service was distinct and did not overlap the usual components of the main service. Justification for medical necessity of both services should also be documented.
** Always check for the latest NCCI edits and payer-specific guidelines regarding modifier XU usage. Ensure thorough documentation to support the distinct and unusual nature of the service.
- Payment Status: Active
- Specialties:Modifier XU can be used by various medical specialties, including but not limited to cardiology, surgery, and any specialty providing procedural services.
- Place of Service:Applicable to various places of service where separate and distinct procedures can be performed, including "Office", "Inpatient Hospital", "Ambulatory Surgical Center," and "Outpatient Hospital."