Can you use modifier 25 with Medicare?


Editorial team Published on

Yes, you can and must use modifier 25 with Medicare when billing a significant, separately identifiable evaluation and management (E/M) service on the same day as a procedure.

✅ Correct Usage Rules

  • Append only to E/M codes.
  • Same physician or same-specialty group.
  • Same day as a minor procedure.
  • Service goes above and beyond standard care.

⚠️ Compliance & Audits

  • High scrutiny from federal auditors.
  • Documentation must prove separate medical necessity.
  • Different diagnoses are not required.
  • Avoid routine or planned procedural visits.