Medical Billing & Coding Modifiers for 2015

Medical billing and coding is an exciting career for anyone looking to establish themselves in a growing field that is always in demand. Professionals in the billing and coding field help provide a pivotal role that helps translate the medical procedures in a way that can be universally understood by insurance companies and health care groups. However, this unique language is also always in flux; a career in medical billing and coding requires a certain flexibility. Codes, modifiers, and more are frequently added, removed, or changed based on different changes in healthcare. For instance, this year, Medicare has rolled out four new modifiers based on changes in procedure. Below, we take a look at what this group looks like.

Effective as of January of this year, Medicare established a series of modifiers -X{EPSU}, to more specifically describe certain procedures, commonly referred to as EPSU modifiers. Individually, they break down like this:


This modifier signifies a separate encounter, or a medical service that is distinct because it occurred during a separate encounter.


This is a service that might be distinct on a document because it was performed by a different practitioner.


This is a distinct service because it’s performed on a separate organ or structure.


This is a unique service that doesn’t overlap to what would normally fall within the scope of that particular service.

The logic behind these modifiers is to serve as a subset of modifier 59, and help bring more accuracy and accountability to one of the most frequently used modifiers in the field. “Modifier 59 is not going away and will continue to be a valid modifier according to Medicare,” said Manny Oliverez at Capture Billing Medical Billing Services. “However modifier 59 should NOT be used when a more appropriate modifier, like a XE, XP, XS or XU modifier, is available.”

These modifiers perform crucial functions for billing departments and insurance companies everywhere, helping to translate the services provided into the claims and funds required for each procedure. However, more specific codes give a much-needed lens into protecting both the insured, and the provider.

For more information on how to begin your career in this increasingly critical role as a medical billing and coding professional, contact ACI today!