Can modifier 25 be billed with 99211?
Asked by: Eleonore Johnson | Last update: June 6, 2025Score: 4.5/5 (40 votes)
What services can be billed with 99211?
- An established patient comes to the office with complaints of urinary burning and frequency. ...
- A patient comes to the office for a blood-pressure check. ...
- A nurse performs a suture removal on a patient whose sutures were placed at a different practice.
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 25 for urgent care?
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.
What is the CMS rule for 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.
MEDICAL CODING MODIFIER 25 - Compliantly bill an E&M and separate service on the same date
Can modifier 25 be added to 99211?
Situations include when services are performed in unusual circumstances, when multiple procedures are performed during the same visit, or when separate and distinct services are provided. Can you bill 99211 with modifier 25? Modifier 25 is not commonly used with 99211, as this code represents a minimal E/M service.
Can I use modifier 25 on a preventive visit?
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 G2211 be billed with 99211?
G2211 can be billed alongside CPT Codes 99202-99205 and 99211-99215. As of 2025, providers can also bill G2211 with Medicare Annual Wellness Visits (G0438 and G0439).
Does modifier 25 or 95 go first?
Since both modifier 25 and 95 can impact payment, list modifier 25 first.
What is the UHC modifier 25 policy?
For example, the description for modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service) specifies that it is to be reported with an Evaluation and Management (E/M) service.
Can you bill both modifier 25 and 57 together?
Both Major and Minor Surgeries on the Same Day When a decision for surgery includes both major and minor surgeries and is made the day of surgery, the E&M billed for the decision must have both modifier –57 and modifier –25 appended.
Can you bill an AWV and E&M together?
The CMS website states “When you provide an annual wellness visit and a significant, separately identifiable, medically necessary Evaluation and Management (E/M) service, Medicare may pay the additional service. Report the additional CPT code with Modifier-25.
Can you bill for office visit and procedure?
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.
What is the CMS guideline for 99211?
Code 99211 describes a face-to-face encounter with a patient consisting of elements of both evaluation (requiring documentation of a clinically relevant and necessary exchange of information) and management (providing patient care that influences, for example, medical decision making or patient education).
Can 99211 be billed alone?
Can 99211 be billed alone? Yes. CPT code 99211 is separately billable. However, it should not be billed on time alone.
What replaced 99211?
Keep 99211 the same.
The changes include both the new and established office or other outpatient E/M codes 99202-99205 (Office or other outpatient visit for the evaluation and management of a new patient …) and 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient…).
What is modifier 25 not used for?
Do not use modifier 25 when billing for services performed during a post-operative period if related to the previous surgery. Related follow-up examinations by the same provider during the global period of a previous procedure are included in that procedure's global surgical package.
What is the 25 modifier on office visits?
The Current Procedural Terminology (CPT) definition of Modifier 25 is as follows: 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.
Do you need modifier 25 with 93000?
You should append modifier -25 to the evaluation and management (E/M) code, but you should not need additional modifiers for 69210, “removal impacted cerumen (separate procedure), one or both ears,” or for 93000, “electrocardiogram, routine ECG with at least 12 leads; with interpretation and report,” because these ...
Can 99211 have a 25 modifier?
The use of modifier 25 requires that the key components be documented with the E&M service. Therefore, CPT code 99211 cannot be appended with modifier 25.
What does 99211 cover?
CPT 99211 is an office or other outpatient visit for the Evaluation and Management (E&M) of an established patient that may not require the presence of a physician. Usually the presenting problem is minimal. Typically, five minutes are spent performing or supervising these services.
Can modifier 25 be used with G2211?
Code G2211 with modifier 25
Previously, CMS did not allow payment for G2211 when the associated E/M service was billed with modifier 25. As of Jan. 1, 2025, G2211 is payable even if the base E/M code includes modifier 25, but only when the additional service is an allowed Part B service.
Can you bill 99401 with modifier 25?
It is also possible to bill 99401 with modifier 25 on the same day as an EM code, if COVID vaccine counseling is provided. OIC Answer: Yes, a vaccine counseling code can be billed on the same day as a vaccine administration code is billed.
Can modifier 24 and 25 be billed together?
You can use modifiers 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) and 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the ...
Does modifier 25 go on 99497?
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).