Modifier lookup
Which modifier, and does it actually bypass the edit
The most searched question here is modifier 59 versus XE, XS, XP and XU. CMS created the four X modifiers to be more specific than 59, and prefers a specific X modifier be used where one describes the situation, reserving 59 for when none of the four fits. If you are here because a claim already denied, start from the denial code lookup instead: the CARC decides whether a modifier is the right fix at all.
20 modifiers in this dataset, cited to CMS / X12 modifier guidance.
20 of 20 shown
- 24Unrelated evaluation and management service by the same physician during a postoperative periodBypasses PTP
- 25Significant, separately identifiable evaluation and management serviceBypasses PTP
- 26Professional componentDoes not bypass PTP
- 50Bilateral procedureDoes not bypass PTP
- 51Multiple proceduresDoes not bypass PTP
- 57Decision for surgeryBypasses PTP
- 58Staged or related procedure by the same physician during the postoperative periodBypasses PTP
- 59Distinct procedural serviceBypasses PTP
- 76Repeat procedure or service by same physicianDoes not bypass PTP
- 77Repeat procedure by another physicianDoes not bypass PTP
- 78Unplanned return to the operating or procedure room for a related procedure during the postoperative periodBypasses PTP
- 79Unrelated procedure or service by the same physician during the postoperative periodBypasses PTP
- 91Repeat clinical diagnostic laboratory testBypasses PTP
- LTLeft sideBypasses PTP
- RTRight sideBypasses PTP
- TCTechnical componentDoes not bypass PTP
- XESeparate encounterBypasses PTP
- XPSeparate practitionerBypasses PTP
- XSSeparate structureBypasses PTP
- XUUnusual non-overlapping serviceBypasses PTP
Denial7 provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.