Can modifier 25 be used with preventive services?
Asked by: Mr. Ansel O'Keefe Jr. | Last update: January 31, 2025Score: 4.7/5 (22 votes)
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 you add modifier 25 to 99396?
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 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.
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.
MEDICAL CODING MODIFIER 25 - Compliantly bill an E&M and separate service on the same date
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 modifier 25 used only for?
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.
How do you know when to bill for both preventive and added services?
If an abnormality is encountered or a preexisting problem is addressed in the process of performing a preventive/wellness visit, and the problem or abnormal finding is significant enough to require additional work to perform the key components of a problem- focused evaluation and management service, then the ...
What are preventive care services?
Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
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).
What is the E&M code for preventive visit?
Codes 99381-99397 are used to report the preventive evaluation and management (E/M) of infants, children, adolescents, and adults. The extent and focus of the services will largely depend on the age of the patient.
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.
Can you bill 99213 and 99396 together?
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.
What is the modifier for 99396?
By appending modifier 25 to the preventive visit code (99396), the provider can accurately report both services and receive appropriate reimbursement for each.
Can you bill an E&M with a planned procedure?
In general, E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service.
What are the requirements for 99396?
Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures; 40-64 years.
What is the modifier 25 for annual wellness visit?
Coding and Billing a Medicare AWV
It is important that the elements of the AWV not be replicated in the medically necessary service. 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 bill 99396 and G0439 together?
Don't bill CPT codes 99381-99397 (comprehensive preventive medicine evaluation and management services) for Medicare services covered by HCPCS codes G0402, G0438, and G0439.
When to use modifier 25 and 59?
Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.”
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.
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.
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.
How do you bill preventive care?
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.
What is modifier 25 in CPT coding?
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.