Can you bill 99497 with modifier 25?
Asked by: Alvina Schoen | Last update: October 5, 2025Score: 4.5/5 (47 votes)
Can modifier 25 be used with preventive services?
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 bill 99497 with E&M?
CPT® instructions note that CPT® codes 99497 and 99498 may be billed on the same day or a different day as most other E/M services, and during the same service period as transitional care management services or chronic care management services and within global surgical periods.
Does 99497 need a 33 modifier?
Yes. Advance care planning is a preventive service only when provided in conjunction with an annual wellness visit and reported with modifier 33 attached to the advance care planning code (e.g., 99497-33).
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.
MEDICAL CODING MODIFIER 25 - Compliantly bill an E&M and separate service on the same date
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).
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.
How do you code 99497?
CPT code 99497 designates advanced care planning, including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified healthcare professional; first 30 minutes, face-to-face with the patient, family member(s), and/or ...
Why is Medicare denying 99497?
Billing improperly for an add-on code without billing for the primary code (99497) is a common reason for claims denials. Primary code 99497 can be billed for the first 30 minutes of the conversation. But if the conversation is less than 16 minutes then a different code (e.g., E/M code) must be used.
Can modifier 25 be used with G0439?
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."
What is the 33 modifier used for?
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.
How often can a CPT code 99497 be billed?
Since 99497 is a 30-minute code, it may be billed once 16 minutes of ACP services are provided. See Table 1 for the ranges of service times when ACP code(s) may be billed.
Can 99497 and 96372 be billed together?
Separate reimbursement will not be allowed for CPT code 96372 when billed with an Evaluation and Management (E/M) Service (CPT code 99201-99499) by the same rendering provider on the same service date.
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.
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 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.
Does 99497 need modifier 25?
Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) must be appended to CPT code 99497.
Is 99497 an E&M code?
This includes the CPT instructions that CPT codes 99497 and 99498 may be Page 3 July 14, 2016 3 billed on the same day or a different day as most other E/M services, and during the same service period as transitional care management services or chronic care management services and within global surgical periods.
Can you bill an 99497 with an AWV?
Yes, CPT 99497 and 99498 can be billed separately as long as minimum time requirements are met. Use modifier -33 to avoid co-pay and deductible. Yes, CPT 99497 and 99498 can be billed separately as long as minimum time requirements are met. Use modifier -33 to avoid co-pay and deductible.
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.
What are the three types of advance directives?
Traditionally, there are two main kinds of advance directives: the living will and the Durable Power of Attorney for Healthcare. The state California also allows the use of a POLST (Physician's Orders For Life‑Sustaining Treatment).
Can you bill G0439 and 99397 together?
These codes must be used for these services for Medicare beneficiaries. CPT codes 99381-99397 for comprehensive preventive medicine evaluation and management services should not be used to bill for Medicare services covered by HCPCS codes G0402, G0438 and G0439.
What is the modifier 25 on the decision tree?
Specifically, modifier 25 is used to identify significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service. So, failure to apply it accurately means that you will not be paid for the additional services you provide.
Can you bill an office visit the day before surgery?
Unlike visits for preoperative clearance that require pre op CPT codes, surgeons can bill for visits to discuss the decision for surgery. Report an E/M code with modifier -57 (decision for surgery) when the encounter is the day before or the day of a major surgery.
What modifier is not commonly used in E&M coding?
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.”