Can I use modifier 25 on a preventive visit?
Asked by: Mr. Osborne Kozey MD | Last update: July 3, 2025Score: 4.7/5 (3 votes)
Can modifier 25 be used with preventive services?
Beginning January 1, 2025, Medicare will allow payment for G2211 when the base E/M services is appended with modifier 25 and provided on the same date as an annual wellness visit, initial preventive physical examination, vaccine or Medicare preventive service.
Can a modifier 25 be added to 99396?
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In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.
Can you bill an office visit with a preventive visit?
Physicians are not prohibited from coding and billing for both preventive and problem-focused E/M services when they are performed during the same appointment.
What are the CMS guidelines for using modifier 25?
Use modifier 25 (same-day significant, separately identifiable E/M service) on the claim when you report critical care services unrelated to the service or procedure that you perform on the same day. You must also document the medical record with the relevant criteria for the respective E/M service you're reporting.
Master Medical Coding Modifiers with Clear Examples!
Which scenario qualifies for modifier 25?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
Can you bill G2211 with a preventive visit?
Beginning in 2025, Medicare will pay for G2211 when the base E/M code is appended with modifier 25 and provided on the same day as an annual wellness visit, vaccine administration, or any Medicare Part B preventive service.
What is required for preventive visit?
- A comprehensive history and physical exam findings;
- A description of the status of chronic, stable problems that are not “significant enough to require additional work,” according to CPT;
- Notes concerning the management of minor problems that do not require additional work;
Does modifier 25 go on office visit or procedure?
Modifier 25 is used to signify that when a separate identifiable evaluation-and-management (E/M) service was performed, which can refer to two evaluation-and-management (E/M) services, or a procedure plus an E/M service.
What is the modifier for preventive services?
Current Procedural Terminology (CPT) modifier 33 can be used when billing for ACA-designated preventive services with a commercial payer. The addition of modifier 33 communicates to a commercial payer that a given service was provided as an ACA preventive service.
Does 99213 need a modifier 25?
If the E/M is not bundled into the stress test, then the Cardiologist's coder can use modifier 25 to indicate that these two services were separate and significant: 99213-25, 93015.
What is the difference between preventive visit and office visit?
The purpose of a preventive visit is to review your overall health, identify risks and find out how to stay healthy. Your plan covers 100% of a preventive visit when you see a doctor in your plan network. * The purpose of an office visit is to discuss or get treated for a specific health concern or condition.
Can you bill a procedure and office visit together?
Sometimes yes, sometimes no. The decision to perform a minor procedure is included in the payment for the procedure, unless a significant and separate E/M is needed, performed and documented. Watch this short video to learn more.
Can you add modifier 25 to 99396?
In this case, the clinician would report the appropriate preventive service visit (such as 99396) on one line of the claim form, followed by the problem-oriented E/M visit (such as 99213) with modifier 25 appended on the next line.
Can you bill 99213 and 99395 together?
can be used 99213 with 99395 at the same visit? Absolutely! You would use the modifier -25 on the 99213. Look at the Preventive Medicine section in CPT® and this is outlined in the narrative explanation prior to the actual listing of codes.
Which of the following is true about attaching modifier 25?
Modifier 25 can only be attached to an E/M code. The E/M service must be significant and clearly separate. Both an E/M code and a procedure code must be submitted by the same physician on the same day as the procedure.
How do you use modifier 25 with preventive visit?
Modifier 25 should always be attached to the E/M code. If provided with a preventive medicine visit, it should be attached to the office-based E/M code (99202–99215). The separately billed E/M service must meet documentation requirements for the code level selected.
How do you bill preventive visits with an office visit?
Can Office and Preventive Visits be Billed Together? The short answer is yes. CPT® codes 99381-99397 are used for comprehensive preventive evaluations that are age-specific, beginning with infancy and ranging through patients 65 years and older, for both new and established patients.
Can you add modifier 25 to 99214?
Yes, you can add modifier 25 to CPT code 99214 if a significant, separately identifiable E/M service is performed on the same day as another procedure.
What is modifier 25 in CPT coding?
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.
What is the new CPT code for preventive visit?
CPT code 99397 designates a comprehensive preventive medicine evaluation and management service for established patients, emphasizing the in-depth assessment involved in preventive care.
What is not covered under preventive care?
What's not considered preventive care? There are times when certain tests and screenings aren't considered preventive care. Things like diagnostic care, bloodwork and sexually transmitted infection (STI) testing may or may not be considered preventive.
Do you use 25 modifier with G2211?
For 2025, Medicare is proposing to allow G2211 with an E/M visit that has a modifier 25 attached, but only when reported in combination with an annual wellness visit. Documentation must support medical necessity of the visit and the nature of the patient care relationship.
Can you bill 99211 with modifier 25?
Do not use modifier 25 on CPT code 99211. Do not use modifier 25 by a physician other than the physician performing the procedure or physician of the same specialty in the same group practice. Do not use modifier 25 when documentation does not support a significant, separately identifiable E/M service.
Can you bill 99497 with modifier 25?
Not typically. However, payers may require modifier 25 on the code for the office E/M service to signify that a significant and separately identifiable office E/M service was provided in addition to the advance care planning (CPT codes 99497 and 99498).