open file.xml ;
if not(/path/to/elem) insert element elem into /path/to ;
save :b ;
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In order to be able to help much, we'll need some sample XML at the very least. But something like this might illustrate the technique:

#!/usr/bin/env perl
use strict;
use warnings;
use XML::Twig;

my $twig = XML::Twig -> parse ( \*DATA ); 

if ( $twig -> get_xpath('/root/params/param[@name="this_setting"]') ) 
+{
    print "Setting for \"this_setting\" already present\n";
}

## add another setting:

my $add_to = $twig -> get_xpath ( '//params', 0 ); 
$add_to -> insert_new_elt ( 'last_child', 'param', { name => "another_
+setting" }, "Content here" );

$twig -> set_pretty_print("indented_a");
$twig -> print;

__DATA__
<root>
    <params>
       <param name="this_setting"></param>
       <param name="that_setting"></param>
    </params>
</root>
[download]

This will check for one parameter (using an xpath expression) but add a different one, to illustrate both. Output is:

Setting already present
<root>
  <params>
    <param name="this_setting"></param>
    <param name="that_setting"></param>
    <param name="another_setting">Content here</param>
  </params>
</root>
[download]

Assuming this is the same question on Stack Overflow I'll offer the same answer:

#!/usr/bin/env perl
use strict;
use warnings;
use XML::Twig;

my $twig = XML::Twig->parsefile( 'your_file.xml' );

#search for "HostProperties" nodes within the tree. You can
#be more specific about this if you need to. 
foreach my $HP ( $twig->get_xpath('//HostProperties') ) {
    #check if it has a "tag" element with a "mac-address" "name" attri
+bute.
    if ( not $HP->get_xpath('./tag[@name="mac-address"]') ) {
        #insert a new element at the end of the entry. 
        $HP->insert_new_elt( 'last_child', 
                     'tag', { 'name' => 'mac-address' },
                     "DE:AD:BE:EF:F0:FF" );
    }
}

#note - pretty printing helps reading, but might
#cause some problems with certain XML constructs. Shouldn't in your sp
+ecific example though. 
$twig->set_pretty_print("indented_a");
$twig->print;

#to save it to a file:
open ( my $output, '>', 'processed.xml' ) or die $!;
print {$output} $twig -> sprint;
close ( $output );
[download]