Does Modifier 25 Affect Payment?

Is modifier 25 needed for EKG?

Yes, you need to add a -25 modifier to your E&M service when billing in conjunction with an EKG or injection admin service done on same DOS.

You’re sure to get a bundling denial without it..

Does modifier 25 affect reimbursement?

Reimbursement Guidelines E/M service codes submitted with modifier 25 appended will be considered separately reimbursable when all of the following apply: The clinical edit is eligible for a modifier bypass (e.g. per edit rationale, CCI modifier indicator = “1”, etc.).

When should you use a 25 modifier?

The Centers of Medicare and Medicaid Services (CMS) requires that modifier 25 should only be used on claims for evaluation and management (E/M) services, and only when these services are provided by the same physician (or same qualified nonphysician practitioner) to the same patient on the same day as another procedure …

What is a modifier 25 in medical billing?

Modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service) is the most important modifier for pediatricians in Current Procedural Terminology (CPT®).

Can modifier 25 and 95 be used together?

Provided the documentation shows there is no relationship between the 99213 and 99442, you can then bill for both services using modifiers 25 and 95 on the 99213.

Can you bill modifier 25 and 59 together?

Modifier 25 may be appended only to a code found in the E/M section of the CPT manual. Modifier 59 is used to indicate a distinct procedural service.