Do you need modifier 25 with ultrasound?
Asked by: Bethany Zboncak MD | Last update: December 14, 2025Score: 5/5 (46 votes)
What is the modifier for ultrasound?
Modifier -26 is the most common modifier used with ultrasounds in the emergency department. When reporting diagnostic ultrasound interpretations by the ED physician, modifier -26 (Professional Component Only) should always be reported to signify that only the professional component is being billed.
When should a 25 modifier be used?
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.
Is modifier 25 needed for EKG?
Yes, you need to add a -25 modifier to your E&M service when billing in conjunction with an EKG or injection admin service done on same DOS. You're sure to get a bundling denial without it.
Can I bill for point of care ultrasound?
The CPT provides that “all diagnostic ultrasound examinations require permanently recorded images with measurements, when such measurements are clinically indicated.” To submit claims for PoCUS examinations, images must be saved and archived in a durable format and able to be reviewed for auditing for at least 5 years ...
MEDICAL CODING MODIFIER 25 - Compliantly bill an E&M and separate service on the same date
Is ultrasound the same as point of care ultrasound?
Simply put, while a regular ultrasound is a comprehensive diagnostic imaging exam, POCUS acts as one part of a bedside assessment. Although its role is different, it can yield valuable information for clinicians throughout hospital systems.
Will insurance pay for an ultrasound?
In most cases, health insurance will cover the ultrasound if it is considered medically necessary by a healthcare professional. For example, if you need a diagnostic ultrasound for abdominal pain or an ultrasound for pregnancy, insurance plans typically cover ultrasounds for those reasons.
Does the CPT code 29125 need a modifier?
Does CPT 29125 Need a Modifier? When billing for the CPT code 29125 (Apply forearm splint), several modifiers may be applicable depending on the specific circumstances of the procedure.
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.
Does 93000 need a 25 modifier?
You should append modifier -25 to the evaluation and management (E/M) code, but you should not need additional modifiers for 69210, “removal impacted cerumen (separate procedure), one or both ears,” or for 93000, “electrocardiogram, routine ECG with at least 12 leads; with interpretation and report,” because these ...
How do I know which modifier to use?
The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).
What are modifiers 25 and 59?
When applied to CPT codes, both modifiers indicate that two services—billed on the same date of service but not typically billed together—were separate and distinct from one another. But, while these modifiers may be similar, they are not the same—and it's crucial to know when and how to use each.
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 is the CPT code for use of ultrasound?
CPT® Code - Diagnostic Ultrasound Procedures 76506-76999 - Codify by AAPC.
What is the modifier for echocardiogram?
Modifier 59 - Distinct Procedural Service: This modifier may be used if the echocardiogram is performed as a distinct service from other procedures on the same day. It is used to indicate that the service is separate and should not be bundled with other procedures.
What is the CMS rule for 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 you put a 25 modifier on 99396?
By appending modifier 25 to the preventive visit code (99396), the provider can accurately report both services and receive appropriate reimbursement for each. Utilizing modifier 25 correctly is crucial to ensure accurate billing and reimbursement for preventive visits that include problem-oriented services.
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.
How do you know if a CPT code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
What is the difference between CPT code 29125 and 29126?
I was looking for a code for this service and saw two: one for a “static” splint and one for a “dynamic” splint. What is the difference between these two splints? Answer: The application codes you will choose from for this claim are 29125 (Application of short arm splint (forearm to hand); static) or 29126 (… dynamic).
Does CPT require a modifier?
According to CPT, the situations when the use of a modifier may be appropriate are: The service or procedure has both professional and technical components. More than one provider performed the service or procedure. More than one location was involved.
Why did insurance not cover ultrasound?
Some of the more advanced types of ultrasounds, such as the 3D and 4D ultrasounds, are not typically covered by insurance. This is because these types of ultrasounds are not deemed medically necessary when 2D ultrasounds can be performed.
Is ultrasound part of deductible?
If your deductible does apply, any money you spend paying for those services will count towards reaching your deductible. If your deductible applies to your ultrasound or non-routine bloodwork, your insurance will pay only after you've reached that deductible.
How can I get an ultrasound without insurance?
You can visit your nearest Planned Parenthood health center for free or low-cost ultrasounds, whether or not you have insurance. Your doctor might also be able to help you find affordable ultrasounds in your area.