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Modifier Workflow

NCCI Distinct Procedural Service Modifiers

Apply an NCCI-associated modifier only when the clinical and procedural facts establish a genuinely distinct service.

Research sequence

  1. 1Check the current PTP edit pair
  2. 2Review the edit rationale and modifier indicator
  3. 3Use the most specific XE, XP, XS, or XU fact when applicable
  4. 4Retain documentation establishing distinctness

Modifiers in this workflow

59Distinct procedural serviceUsed only when services that normally edit together are distinct under documented circumstances and no more specific modifier applies.DetailsXESeparate encounterNCCI-associated modifier for a service distinct because it occurred during a separate encounter.DetailsXPSeparate practitionerNCCI-associated modifier for a service distinct because it was performed by a different practitioner.DetailsXSSeparate structureNCCI-associated modifier for a service distinct because it was performed on a separate organ or structure.DetailsXUUnusual non-overlapping serviceNCCI-associated modifier for a service that does not overlap the usual components of the main service.Details

Use current official or licensed modifier definitions and payer instructions. A modifier communicates a supported claim fact; it does not create coverage or medical necessity.