What is modifier 25 used for?
What is modifier 25 used for?
Modifier 25 – this Modifier is used to report an Evaluation and Management (E/M) service on a day when another service was provided to the patient by the same physician or other qualified health care professional.
Does modifier 25 affect payment?
Currently, if a claim is received by CMS that includes an E&M service with a Modifier 25 and a procedure, both the E&M and the procedure are reimbursed at 100 percent of the allowed amount.
How do you bill for preventive services?
As long as service is clearly documented and distinct from the documentation of the preventive service, CPT suggests submitting a preventive medicine services code (99381-99397) for the routine exam and the appropriate office visit code (99201-99215) with modifier -25, “Significant, separately identifiable [E/M] …
What code set does CPT fall under?
In 1983, CPT was adopted as part of the Centers for Medicare & Medicaid Services (CMS), Healthcare Common Procedure Coding System (HCPCS). This HCPCS code set is divided into two principal subsystems: (1) Level I of the HCPCS, which comprised the CPT and (2) Level II of the HCPCS (see Marcia Nusgart’s article).
Is modifier 25 needed for immunizations?
When an evaluation and management service (other than a preventive medicine service) is provided on the same date as a prophylactic immunization, modifier -25 may be appended to the code for the evaluation and management service to indicate that this service was significant and separately identifiable from the …
Can modifier 25 be used with new patient visit?
Palmetto GBA: , CPT Modifier 25. Documentation in the patient’s medical record must support the use of this modifier. These codes are ‘new patient’ codes and are automatically excluded from the global surgery package, meaning that they are reimbursed separately from surgical procedures.
Can modifier 25 and 59 be used together?
A: Yes, the BCBSTX Provider website has additional links to support correct claims billing using modifiers 25 and 59. Refer to the General Reimbursement Information under Standards and Requirements. CPT, copyright 2018, by the American Medical Association (AMA).
Can you bill an office visit with a preventive visit?
Coverage of preventive visits varies by insurer, so it is important to be aware of the patient’s health plan. When billing for a preventative medicine visit, it is legal to also bill for an evaluation and management service if a patient wants a medical problem addressed at the time of their yearly physical exam.
