Can you bill 99213 with modifier 25?
Asked by: Zackary Beatty | Last update: April 29, 2025Score: 5/5 (40 votes)
Can modifier 25 be used with 99213?
Code99213,Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making, would be reported with modifier 25 appended to indicate that a significant, separately identifiable E/M ...
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 codes can be billed with modifier 25?
Medicare does require modifier 25 for E/M services provided in conjunction with other vaccine administration codes, including CPT codes 90480, 90460, 90461, 90471, 90472, 90473 and 90474. Private payers may have different policies.
How do I bill 99213?
Proper documentation is crucial for supporting the use of the 99213 code. It should include detailed information about the patient's medical history, the nature of the presenting problem, the scope of the examination, the medical decision-making process, and any treatments or interventions provided.
MEDICAL CODING MODIFIER 25 - Compliantly bill an E&M and separate service on the same date
Is 99213 a preventive code?
However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.
How does modifier 25 affect payment?
Automatic reduction in payment for the second code to account for what they perceive to be “overlap” between the two codes (e.g., a Preventive Medicine Service E/M code reported with an Office or Other Outpatient Service E/M code appended with modifier 25 allows payment of the Preventive Medicine Service code at 100 ...
Can you bill 99213 and 20610 together?
Per CCI edits, CPT codes 20610-RT and 99213-25 cannot be billed together; however a modifier is allowed with supporting documentation.
Does modifier 25 or 95 go first?
Since both modifier 25 and 95 can impact payment, list modifier 25 first.
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.
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.
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 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.
Can you bill 99213 for telehealth visit?
During the COVID-19 public health emergency, many physiatrists are performing standard office visits via telehealth. These services should be billed using standard E/M codes. For example, a level 3 office visit provided to an established patient via telehealth should be billed using code 99213.
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.
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 are the rules for CPT code 99213?
What is CPT code 99213 used for? CPT code 99213 is used for an established patient office or other outpatient visit that requires a medically appropriate history and/or examination and low level of medical decision-making along with 20 minutes of encounter time.
Can you bill an office visit and injection together?
It is true that an evaluation and management code, an E/M or office visit, can be reported with a minor procedure such as an injection, but only if the E/M is significant and separate and exceeds the “pre-service evaluation” that is inherent to the injection.
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.
Can I use a modifier 25 on CPT 99396?
By appending modifier 25 to the preventive visit code (99396), the provider can accurately report both services and receive appropriate reimbursement for each.
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.”
Can an office visit and preventive visit be billed together?
CPT states that if a new or existing problem is assessed and managed at the time of the preventive visit, the physician should also bill a problem-oriented visit (an office visit) on the day of the preventive care.
Can you bill 99395 and 99213 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.