# XE Modifier: Billing a Second NEMT Trip for the Same Rider on the Same Day

Canonical URL: https://nemtguide.com/glossary/xe-modifier/ · Updated 2026-10-02

XE is the HCPCS modifier for a separate encounter: a service that is distinct because it happened at another time on the same date. On NEMT claims it marks a second or later trip for the same rider that day, so the line is not denied as a duplicate. Indiana's August 19, 2025 bulletin asks for it in place of 76. Other programs use 59, 76, or their own codes.

- XE means "separate encounter, a service that is distinct because it occurred during a separate encounter." CMS created it on January 1, 2015 as a narrower form of modifier 59.
- Indiana wants XE on every trip after the first for a member on one date of service, and never 76, under bulletin BT2025119 (August 19, 2025).
- Do not put XE on the legs of a trip where the driver waited. Indiana counts that as one trip.
- South Dakota uses 59, Medi-Cal uses 76 with the times and destinations in box 19, and Ohio uses UA and UB.
- Medicaid unit limits allow 2 units of A0130 per claim line from October 1 to December 31, 2026, and each line split off by a modifier is checked on its own.

## What the XE modifier means

CMS added four modifiers to the HCPCS code set on January 1, 2015 as narrower versions of modifier 59, the CPT modifier for a distinct procedural service. Its notice to Medicare contractors (Transmittal 1422, August 15, 2014) called 59 the most widely used modifier and one tied to considerable abuse. The four are:

- **XE:** separate encounter, a service that is distinct because it occurred during a separate encounter.
- **XP:** separate practitioner.
- **XS:** separate structure, such as a different organ.
- **XU:** unusual non-overlapping service.

Only XE fits a ride. CMS's guidance (MLN booklet, April 2026) says to use XE only to describe separate encounters on the same date of service, to use the X modifiers instead of 59 whenever possible, and that medical documentation must support the modifier. Transmittal 1422 adds that putting XE and 59 on the same line is incorrect.

Two older CPT modifiers also appear on ride claims. Modifier 59 marks a distinct procedural service. Modifier 76 marks a repeat procedure or service by the same physician or other qualified health care professional, and the Medicaid NCCI manual (January 1, 2026) says it does not bypass a code pair edit. Indiana's bulletin says 76 is not appropriate for transportation claims and that XE fits better, because it simply marks a separate encounter.

XE is about billing, not booking. A trip booked on short notice is covered in [same-day NEMT trips](https://nemtguide.com/guides/same-day-nemt-trips/).

## Why a second trip needs a modifier

Federal rule [42 CFR 447.45](https://www.ecfr.gov/current/title-42/section-447.45) makes every state Medicaid program check, before it pays, that a claim does not duplicate one it already reviewed. A second trip for the same member on the same day bills the same base code, so without a marker it looks like the first trip billed twice. The remittance shows reason code 18, "Exact duplicate claim/service." See [claim adjustment reason codes](https://nemtguide.com/glossary/claim-adjustment-reason-codes/).

Unit limits are the second reason. CMS's Medicaid NCCI program sets medically unlikely edits, the most units of one code a provider can bill for one member on one date of service. Medicaid applies them to each claim line separately, and a line over the limit denies in full. For dates of service from October 1 to December 31, 2026, the practitioner file sets these limits:

| Code | What it is | Units per line |
|---|---|---|
| A0130 | Wheelchair van | 2 |
| A0100 | Taxi | 2 |
| A0110 | Bus, intrastate or interstate carrier | 2 |
| A0425 | Ground mileage, per statute mile | 250 |

When a modifier such as XE, 59, or 76 puts the same code on separate lines, the NCCI manual says each line is checked against the limit on its own. The same manual notes that state Medicaid programs may limit these modifiers on some codes, and states set their own exceptions. Indiana, for one, lets A0425 go above 250 units on a date of service.

## Which modifier each program wants for a second trip

No national rule covers rides, so bill the modifier your program names:

| Program | Modifier on a later trip that day | What else it asks |
|---|---|---|
| Indiana Medicaid (bulletin BT2025119, August 19, 2025) | XE on each trip after the first, never 76 | No XE on the legs of a trip where the driver waited |
| South Dakota Medicaid (manual updated August 2026) | 59, paid at 100 percent of the fee | Up to 4 one-way trips a day |
| Medi-Cal fee-for-service (page updated June 2023) | 76 may be added to each code | Time of day and destinations in box 19 |
| Ohio Medicaid (rule in effect August 1, 2026) | UA for the second trip, UB for the third | Same vehicle type, to or from the same type of place |
| Idaho waiver rides (handbook, March 30, 2026) | 76 on every trip after the first | Applies to commercial providers. The first trip has no modifier. |

**South Dakota.** Its modifier list (effective July 1, 2026) carries XE with no payment effect, but its community transportation manual bills extra same-day trips with 59. A rider who goes to one clinic and home, then out and home again later, bills line 1 as A0120 with 2 units and line 2 as A0120 59 with 2 units. In town the fee schedule allows $5.20 per one-way trip from July 1, 2026, so up to $20.80 for the four trips. A third round trip is the rider's own cost, and you may not bill it under another date of service.

**Ohio.** UA and UB are information modifiers in the appendix to rule 5160-15-28, used on the wheelchair van codes A0130, S0209, and T2001 and on ambulance codes. They mark an additional trip by the same person on the same day, in the same type of vehicle, to or from the same type of location. See [U modifiers](https://nemtguide.com/glossary/u-modifiers/) for Ohio's other letters.

**Medi-Cal.** The manual pairs 76 with a paper trail: for each trip, the time of day and the points of destination go in box 19, and without them a later trip may deny as a duplicate. Its billing examples (February 2025) also want the full pickup and drop-off addresses in box 19 or an attachment when you bill mileage.

**Idaho.** The 76 rule in the table covers waiver non-medical transportation, rides to everyday places such as the grocery store. Idaho's ambulances also use 76 on the second base rate and mileage when they return to base and carry the same person again that day.

## Indiana's XE rule in practice

Bulletin BT2025119 calls XE an informational modifier. The first trip of the day carries no XE, and each additional trip on that date carries it, on the same claim. Indiana wants every service for one member on one date on one claim, with two exceptions: brokered and nonbrokered services go on separate claims, and trips at different levels of service, such as a walk-on trip out and a wheelchair trip back, go on two claims.

Three rules decide whether a line is a new trip:

- **A simple round trip is one line.** At one level of service, bill both runs on one line with 2 units, and all the miles on one mileage line.
- **A wait makes it one trip.** If the driver stays while the member is seen, the legs are a single trip, billed with waiting time where it applies and never with XE. See [NEMT wait time billing](https://nemtguide.com/guides/nemt-wait-time-billing/).
- **A stop along the way is not a trip.** A lab stop on the way home, with the vehicle waiting outside, stays part of one trip.

**Example.** A wheelchair member goes from home to a doctor's office, 6 miles, and the van leaves. Later it takes her from the office to an imaging center, 3 miles, and leaves again. Then it takes her home, 7 miles. That is three trips, the pattern in the bulletin's first example.

| Line | Codes | Pays at IHCP rates from January 1, 2026 |
|---|---|---|
| 1 | A0130 with RP (residence to physician's office) | $31.79 |
| 2 | A0130 with PD (office to diagnostic site) and XE | $31.79 |
| 3 | A0130 with DR (diagnostic site to residence) and XE | $31.79 |
| **Total** | | **$95.37** |

No line bills mileage. Indiana deducts the first 10 miles of every one-way wheelchair trip, does not require mileage on trips under 10 miles, and processes it as a denied line if you bill it anyway.

The module adds one more XE case: a member who rides alone once and shares a ride once on the same day. The shared trip takes XE, as T2004 with XE after the solo T2003 trip, and modifier 59 is not appropriate. See [the TT modifier](https://nemtguide.com/glossary/tt-modifier/) for shared rides. Trips brokered by Verida are billed to Verida, so check its claim instructions for the same-day modifier.

## How to bill a second same-day trip without a denial

1. **Decide whether it is a new trip.** A wait or a stop along the way keeps it one trip. A new pickup after the driver left is a new trip.
2. **Keep the day on one claim** where your program asks for that, as Indiana does, with the first trip unmarked.
3. **Add your program's modifier** to each later trip's lines: XE in Indiana, 59 in South Dakota, 76 for Medi-Cal, UA or UB in Ohio.
4. **Never put XE and 59 on the same line.** Use the one your payer names.
5. **Stay within the unit limit.** Put each extra trip on its own line rather than adding units to one line past the payer's limit.
6. **Record the times.** Medi-Cal wants the time of day and destinations in box 19, and CMS says documentation must support the modifier. Keep pickup and drop-off times and addresses on the driver's ticket for every trip.
7. **Fix a duplicate denial by rebilling with the right modifier.** Send it as a corrected or new claim, the way your payer says. A copy with no change denies again. See [how to avoid duplicate-claim denials](https://nemtguide.com/guides/corrected-nemt-claims/#how-to-avoid-duplicate-claim-denials) and [NEMT claim denials](https://nemtguide.com/guides/nemt-claim-denials/#duplicate-and-split-billing-denials).

## Frequently asked questions

### What does the XE modifier mean?

CMS defines XE as "Separate encounter, a service that is distinct because it occurred during a separate encounter." It took effect January 1, 2015, as one of four modifiers, XE, XP, XS, and XU, that narrow modifier 59. CMS says to use XE only for separate encounters on the same date of service. On a ride claim, each trip is the encounter.

### What is the difference between XE and modifier 59?

Modifier 59, distinct procedural service, is a CPT modifier that covers many situations. XE covers one: a separate encounter on the same day. CMS says to use XE instead of 59 whenever possible, and that putting both on one line is incorrect. Indiana says 59 is not appropriate for a second trip, while South Dakota still bills extra same-day trips with 59.

### Should I use modifier 76 for a second NEMT trip?

Only where your payer asks for it. Modifier 76 means a repeat procedure or service by the same physician or other qualified health care professional. Indiana told providers on August 19, 2025 to stop using it on transportation claims and use XE. Medi-Cal still lets you add 76 to each code, with the times and destinations in box 19, and Idaho uses it on waiver rides.

### Do I need XE on a round trip?

Not in Indiana for a simple round trip at one level of service. Bill both runs on one line with 2 units and all the miles on one mileage line. XE goes on the lines for any other trip that day, such as a ride to a second appointment. A trip where the driver waited is one trip and never takes XE.

### Why was my second trip denied as a duplicate?

The payer saw two lines that looked the same: same member, date, code, and units. The remittance usually shows reason code 18, "Exact duplicate claim/service." Add the modifier your payer names for a later trip, keep the trip times on the driver's ticket, and rebill the trip the way your payer says, never as an unchanged copy.

## Official resources

- [CMS: Proper Use of Modifiers 59, XE, XP, XS and XU](https://www.cms.gov/files/document/mln1783722-proper-use-modifiers-59-xe-xp-xs-xu.pdf)
- [Indiana Health Coverage Programs: bulletin BT2025119](https://www.in.gov/medicaid/providers/files/bulletins/BT2025119.pdf)
- [South Dakota Medicaid: Community Transportation manual](https://dss.sd.gov/docs/medicaid/providers/billingmanuals/Professional/Community_Transportation.pdf)
- [Ohio Administrative Code: rule 5160-15-28 and appendix](https://codes.ohio.gov/ohio-administrative-code/rule-5160-15-28)