Unraveling Modifier 25

TMA regularly receives calls, emails, and Hassle Factor Logs related to the proper usage of modifier 25.

For that reason, we’ve teamed up with UnitedHealthcare and the American Medical Association to offer this free webinar on using modifier 25 correctly. The 38-minute, archived presentation applies to all payers, not just UHC. 

Here are a few reminders about using modifier 25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service): 

  • Use modifier 25 with E&M codes only. 
  • Modifier 25 is not restricted to a specific level of E&M service.  
  • Do not use modifier 25 to report an E&M service that results in a decision to perform a major (i.e., 90-day global period) surgery. 
  • You may use modifier 25 to report a problem-oriented E&M service you provide on the same day as a preventive-medicine E&M service. 
  • The E&M service may be prompted by the symptom or condition for which you performed the other service or procedure. Different diagnoses are not required for reporting the service or procedure and the E&M service on the same date. 

For Medicare guidelines regarding modifier 25, see the Medicare Claims Processing Manual, Chapter 12 (PDF), Section 30.6.6 

If you need more in-depth training on modifier use after viewing the webinar, contact TMA Practice Consulting at (800) 523-8766 or practice.consulting[at]texmed[dot]org. Having trouble appealing a claim dealing with modifier 25 — or any other reason? Report your problem to the TMA Hassle Factor Log, and TMA will help you resolve it.  

Revised Sept. 9, 2013 

TMA Practice E-Tips main page 

Last Updated On

June 03, 2016

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