Can modifier 25 be used with G0439?
Asked by: Dr. Lois Lubowitz | Last update: April 22, 2025Score: 4.2/5 (23 votes)
What is the modifier 25 for annual wellness visit?
Modifier 25 should be appended to the office or other outpatient visit code to indicate that a significant, separately identifiable E/M service was provided on the same date as the preventive medicine E/M service, and the appropriate preventive medicine E/M service is additionally reported without a modifier.
Can you use modifier 25 with Medicare?
The Centers for Medicare & Medicaid Services (CMS) requires that modifier 25 be used only on claims for E/M services and only when the E/M service is provided by the same physician on the same day as another procedure or service.
Can modifier 25 be used with G0463?
You may need a -25 modifier on G0463 if the other services performed have a status indicator of S, T, or V.
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.
Modifier 25 medical coding
Can G0439 have a 25 modifier?
Along with HCPCS G0438 or HCPCS G0439, CPT code modifier -25 must be appended to the medically necessary E&M service. CPT guidelines define the -25 modifier as "Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service."
Can you bill 99214 and G0439 together?
Medicare does discourage this and says there is too much 'crossover' between these two preventive services. We usually see a 99213 or 99214 with a G0438 or G0439 to represent the problem management outside the AWV. If you bill G0438/G0439 and a 99397, recognize that Medicare does not cover the 99397.
When not to use modifier 25?
Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service.
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.
Can modifier 25 be used with G0378?
appropriate to use modifier 25 on any code other than an E/M code. E/M codes include CPT codes 99201-99499 or any HCPCS code that is used to identify an E/M service, including, but not limited to, G0378, G0379, G0438, G0439, or G0463.
What modifier is not accepted by Medicare?
GZ - Service is not covered by Medicare
The GZ modifier identifies that 1) an item or service is expected to be denied as not reasonable and necessary, and 2) no advance notice of non-coverage was supplied to the member.
Can modifier 25 be used with 99223?
The requirement to conduct reviews of claims for services for CPT codes 99221 through 99223, 99251 through 99255 and 99238 that are furnished on the same date as inpatient dialysis is deleted. These codes are separately payable using modifier “ -25".
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.
What is included in G0439?
HCPCS code G0439 for Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit as maintained by CMS falls under Counseling, Screening, and Prevention Services.
Does Medicaid recognize modifier 25?
The Centers of Medicare and Medicaid Services (CMS) requires that Modifier 25 should only be used on claims for 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 or other service.
What is the modifier for Medicare wellness visit?
Coding and Billing a Medicare AWV
Physicians must append modifier -25 (significant, separately identifiable service) to the medically necessary E/M service, e.g. 99213-25, to be paid for both services.
Can you add modifier 25 to G0402?
6223.3 Contractors shall allow payment for a medically necessary E/M service (CPT code 99201 – 99215) at the same visit as the IPPE (G0344 or G0402, whichever applies based on the beneficiary's enrollment date) when billed with modifier-25.
What is G0 condition code?
Use 'G0' condition code when multiple medical visits occur on same day in same revenue center but visits were distinct and constituted independent visits. i.e. 510 or 450 revenue codes. Verify coding and ensure there are no duplicate revenue code lines billed.
Can a modifier 25 be added to 99396?
Get to know them
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.
What is the CMS modifier 25 rule?
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.
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.
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).
Does G0439 need a modifier?
Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient's illness or injury or to improve the functioning of a malformed body part. You can only bill G0438 or G0439 once in a 12-month period.
Does modifier 25 go on office visit or procedure?
Modifier 25 indicates on the day of a procedure, the patient's condition required a significant, separately identifiable E/M service, above and beyond the usual pre- and post-operative care associated with the procedure or service performed. E/M service may occur on the same day as a procedure.
Will Medicare pay for two different doctor visits on the same day?
The para states that as for all other E/M services except where expressly noted, the Medicare Administrative Contractors (MACs) may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician ...