Can I use modifier 25 and 27 together?

Editorial team InsuredAndMore.com Published on October 31, 2026

Modifier 25 and modifier 27 are not typically appended to the same individual code line, but they can appear on the same multi-encounter institutional claim when a hospital outpatient facility reports multiple separate evaluation and management (E/M) services alongside a procedure.

Key Differences in Usage

Modifier 25: Indicates a significant, separately identifiable E/M service performed by a provider on the same day as a procedure or other service. It is used extensively in professional (physician) claims.
Modifier 27: Indicates multiple outpatient hospital E/M encounters for a patient on the same date. It is exclusive to hospital facility claims (such as an emergency department or outpatient clinic) and does not apply to professional physician billing.

How They Interact on a Claim

Different Claim Levels: Modifier 27 belongs on the institutional/facility claim form (UB-04), while Modifier 25 is standard on the professional claim form (CMS-1500).
Combined Scenarios: If a patient has multiple hospital outpatient encounters on the same day—and one or more of those distinct encounters also involves a separate procedure alongside an E/M service—the facility might report multiple E/M codes using modifier 27 for the subsequent visit, while a distinct line item or the professional claim utilizes modifier 25 for the separate service.

Can modifier 27 be used on a professional claim?

No, modifier 27 cannot be used on a professional claim.

Key Rules for Modifier 27

Institutional Use Only: Modifier 27 is exclusive to hospital outpatient facility billing and must be reported on the UB-04 claim form (or electronic equivalent).
Not for Professionals: Physician practices and professional providers submitting CMS-1500 claim forms cannot use modifier 27.
Purpose: It identifies multiple, separate, and distinct outpatient Evaluation and Management (E/M) encounters for the same patient on the same calendar date at a hospital setting (such as an emergency department or clinic).
Professional Alternative: If a physician performs a significant, separately identifiable E/M service on the same day as another service or procedure, they should use modifier 25 on their professional claim instead.

When not to use modifier 25?

Do not use CPT modifier 25 when the evaluation and management (E/M) service is an integral, routine part of a procedure or when the visit's sole purpose is to perform that procedure.

When Not to Use Modifier 25

Routine Pre-operative or Post-operative Care: Do not use it for standard, expected pre-op exams (like getting basic consent) or routine post-op checkups that are already included in the global fee of a procedure.
Sole Purpose is a Procedure: Do not use it when a patient comes in just for a minor procedure (such as a simple lesion removal) and there is no separate, medically necessary E/M service provided.
Decision for Major Surgery: Do not use modifier 25 when an E/M visit results in the decision to perform a major surgery with a 90-day global period; use modifier 57 instead.
No Separate Documentation: Do not use it if the medical record does not clearly show a distinct, stand-alone problem and separate medical decision-making that goes beyond the normal work of the procedure.
Inappropriate Codes: Do not append modifier 25 to code G2211 or code 99211.
Different Specialties / Providers: Do not use it if the E/M service and the procedure are performed by different, unrelated specialties or separate group practices where rules do not allow it.
Scheduled Procedures without New Issues: Do not use it for a pre-scheduled, routine procedure where no new, distinct symptoms or unexpected problems are evaluated during the encounter.

You can review the official guidance provided by the American Medical Association for more details on correct billing practices.

Can modifiers 24 and 25 be billed together?

Yes, medical billing modifiers 24 and 25 can be billed together on the same Evaluation and Management (E/M) code in specific, rare circumstances.

When You Can Use Both

You can report both modifiers on a single E/M service code when all of the following rules are met:

Modifier 24: The patient is in a global postoperative period (10 or 90 days) from a previous, unrelated surgery, and the doctor performs an E/M visit for a completely separate condition.
Modifier 25: During that same-day visit, the provider also performs a separate, minor procedure for the new condition, and the E/M work is significant and separately identifiable.

Proper Billing Rules

Placement: Attach both modifier 24 and modifier 25 to the same E/M procedure code.
Sequencing: Always place modifier 24 first and modifier 25 second. Computer systems check postoperative global periods first, so 24 must lead to pass primary billing edits.
Documentation: Clear, separate medical records must prove the visit and procedure are unrelated to the original surgery.

What is the purpose of modifier 27 in medical billing?

Modifier 27 is used by hospital outpatient facilities to report multiple, separate Evaluation and Management (E/M) encounters for the same patient on the same calendar date.

Purpose and Function

Identifies Distinct Visits: It tells the insurance company that a second or subsequent E/M service on the same day is a separate, medically necessary encounter rather than a duplicate claim.
Facility Exclusive: It is strictly for hospital outpatient departments, emergency rooms, and clinics billed on institutional claim forms (like the UB-04); individual doctors cannot use it.
Resource Accounting: It justifies the extra hospital resources and staff used when a patient returns for a completely new issue later the same day.

Common Usage Example

A patient goes to the hospital emergency room in the morning for a sprained wrist.
Later that same evening, the patient returns to the hospital clinic for a severe, unrelated stomachache.
The hospital appends modifier 27 to the second E/M code to show the visit is separate and distinct.

MEDICAL CODING MODIFIER 25 - Compliantly bill an E&M and separate service on the same date

9 related questions found

Can you bill modifier 25 and 27 together?

Key Differences in Usage

Modifier 25: Indicates a significant, separately identifiable E/M service performed by a provider on the same day as a procedure or other service. It is used extensively in professional (physician) claims.
Modifier 27: Indicates multiple outpatient hospital E/M encounters for a patient on the same date. It is exclusive to hospital facility claims (such as an emergency department or outpatient clinic) and does not apply to professional physician billing.

How They Interact on a Claim

Different Claim Levels: Modifier 27 belongs on the institutional/facility claim form (UB-04), while Modifier 25 is standard on the professional claim form (CMS-1500).
Combined Scenarios: If a patient has multiple hospital outpatient encounters on the same day—and one or more of those distinct encounters also involves a separate procedure alongside an E/M service—the facility might report multiple E/M codes using modifier 27 for the subsequent visit, while a distinct line item or the professional claim utilizes modifier 25 for the separate service.

What is the difference between modifier 25 and 27?

Modifier 27 and modifier 25 both involve evaluation and management (E/M) services on the same day, but modifier 25 is used for a separate E/M service with a procedure on the same day, while modifier 27 is used for multiple separate E/M hospital encounters on the same day.

Core Differences

Modifier 25

Definition: Significant, separately identifiable E/M service by the same physician on the same day of a procedure or other service.
Setting: Common in professional claims, physician offices, and outpatient clinics.
Purpose: Shows the provider did extra work above and beyond the normal pre- or post-operative care tied to a minor procedure done that day.
Example: A patient sees a doctor for knee pain, and the provider performs a joint injection during that same visit.

Modifier 27

Definition: Multiple outpatient hospital E/M encounters on the same date.
Setting: Exclusive to hospital facility and institutional claims (UB-04), such as emergency departments and multiple hospital clinics. Prohibited for standard physician professional claims (CMS-1500).
Purpose: Appended to the second and subsequent E/M codes to prove a distinct, separate encounter happened earlier or later that day.
Example: A patient goes to the emergency room in the morning for an injury and returns later that same day for an unrelated issue.

Comparison Table

Feature	Modifier 25	Modifier 27
Primary Use	E/M service + Procedure	Multiple E/M encounters (Facility only)
Claim Type	Professional (CMS-1500) & Facility	Institutional / Facility only (UB-04)
Who Reports It	Physicians / Qualified Healthcare Professionals	Hospital Outpatient Departments
Key Requirement	Work goes above and beyond standard pre/post-op care	Separate and distinct patient arrivals/encounters on same day

What are common modifier 25 mistakes?

Common modifier 25 mistakes involve billing an evaluation and management (E/M) service alongside a same-day procedure without proving that the extra work stands completely separate from routine pre- and post-procedure care.

Top Mistakes with Modifier 25

Weak or Missing Documentation: Failing to record a distinct history, exam, or medical decision-making process for the separate problem. If it is not clearly written in the chart, auditors treat the E/M service as unproven.
Automatic Blanket Use: Appending the modifier to every single procedure visit by default or relying on software defaults without checking if the service truly qualifies.
Billing Routine Pre-Procedure Work: Using the modifier when the visit only covers the standard, required assessment done right before a scheduled minor procedure.
Confusing Modifier 25 with Modifier 57: Appending modifier 25 to major surgeries that carry a 90-day global period instead of using modifier 57 for the decision to perform major surgery.
Confusing with Modifier 59 or 24: Mixing up modifier 25 (same-day minor procedure and E/M) with modifier 59 (distinct procedural services) or modifier 24 (unrelated E/M during a global period).
Appending to Non-E/M Codes: Placing modifier 25 on a procedure code instead of strictly attaching it to the eligible E/M code.

What are the rules for modifier 25?

Modifier 25 is a billing code used to report a significant, separately identifiable Evaluation and Management (E/M) service performed by the same physician on the same day as another procedure or service.

Core Rules for Modifier 25

Append to E/M Only: Add modifier 25 only to the E/M service code (such as an office or outpatient visit), never to the procedure code itself.
Same Day and Same Provider: The E/M service and the procedure must occur on the same calendar date and be performed by the same physician or same-specialty group.
Above and Beyond: The work done during the visit must go beyond the usual pre-operative and post-operative care tied to the procedure.
Different Diagnoses Not Required: You do not need a separate secondary diagnosis code for the E/M service, though the clinical reason must be distinct.
The "Stand-Alone" Test: Ask if the E/M visit would still be valid and billable on its own if the procedure had not been performed that day. If the answer is no, the modifier does not apply.

When to Use It

Performing a routine preventive exam, but discovering a new acute problem that requires separate medical decision-making and treatment.
Evaluating a chronic issue that worsened, leading to a decision to perform a minor surgical procedure (like a lesion removal or joint injection) on the same day.

When NOT to Use It

For pre-scheduled or planned minor procedures where no new distinct clinical work occurred during the visit.
For major surgical procedures with a 90-day global period (use modifier 57 for those decisions instead).
On routine codes like subsequent nursing facility care or minimal services where a separate evaluation is not justified.

How do you avoid 25 modifier denials?

To avoid modifier 25 claim denials, you must clearly document that the evaluation and management (E/M) service was significant, distinct, and completely separate from the minor procedure performed on the same day.

Separate Your Documentation

Write distinct sections: Physically separate the E/M notes from the procedure notes in the medical record.
Avoid weak phrasing: Do not write phrases like "patient is here for the procedure." Use clear language that shows you evaluated a separate condition.
State independent work: Explicitly write down your separate cognitive efforts, such as reviewing alternative treatments or performing a distinct risk-benefit analysis.

Apply the "Would It Be Billable?" Test

Check necessity: Ask yourself if the E/M service would still be medically necessary and billable if you did not perform the procedure that day.
Go beyond routine care: Ensure your work is above and beyond the minimal pre-operative and post-operative care that is already bundled into the procedure.
Use distinct diagnoses: Assign separate ICD-10 diagnosis codes to the E/M visit when clinically appropriate, as this helps satisfy private payer algorithms.

Review Payer Rules and Appeal Denials

Check specific guidelines: Review policies for individual insurance companies, as private payers often have stricter or different requirements than Medicare.
Appeal unfair rejections: Challenge unjust denials with the American Medical Association templates and documentation. Maintaining a high appeal success rate discourages automated insurer pushback.