Modifier 25 Basics Modifier 25 Definition: Significant, separately identifiable Evaluation and Management (E/M) by the same physician or other qualified health care professional on the same day of the procedure or other service. Let’s break the definition down: Significant: In order to support an E/M code, the work must be significant. This can be defined […]
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modifier 25
August 31, 2020Modifiers
Modifier 25 vs 59: There has been much confusion over the difference between and use of modifiers 25 and 59. In 2008, the description of modifier 59 was edited in the CPT manual to clarify the distinction between two. When applied to CPT codes, both modifiers indicate: two services billed on the same date of […]
Medicare and other providers have increased scrutiny of modifier 25, which is used when something “distinct and different” is needed on the same day as an evaluation and management (E&M) service. The Office of the Inspector General (OIG) has identified modifier 25 as a potential area of overuse or misuse, thereby increasing the potential for […]
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