Is modifier 25 a CPT code or HCPCS?
Asked by: Jamil Schulist | Last update: January 23, 2026Score: 4.6/5 (42 votes)
What is the modifier 25 for HCPCS?
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.
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.
How to write a CPT code with modifiers?
CPT modifiers are added to the end of a CPT code with a hyphen. In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second.
What are HCPCS modifier codes?
HCPCS modifiers are two characters (numbers or letters) added to the end of an HCPCS Level I or Level II code. These modifiers provide additional data about medical services, procedures, or supplies without changing the code meanings.
What is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
What is a HCPCS VS CPT code?
HCPCS stands for Healthcare Common Procedure Coding System and is used to classify medical procedures and services. Meanwhile, CPT, or Current Procedural Terminology, is used to describe medical procedures and services.
What are the HCPCS codes?
The Healthcare Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs.
What is the difference between a CPT code and a modifier?
Modifiers consist of two digits. They can be letters or numbers or one of each. The modifier is appended to the 5-digit CPT code. The modifier does not change the CPT code but calls attention to special circumstances associated with the service or procedure that the patient received.
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.
Which of the following is true about attaching modifier 25?
Modifier 25 can only be attached to an E/M code. Both an E/M code and a procedure code must be submitted by the same physician on the same day as the procedure.
How to use modifier 25 correctly?
Appending the CPT modifier 25 to an E/M service code on a claim indicates the code is a significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure or other service, the AMA issue brief (PDF) explains.
What is the HCPCS manual?
Healthcare Common Procedure Coding System (HCPCS) is a standardized code system necessary for medical providers to submit healthcare claims to Medicare and other health insurances in a consistent and orderly manner.
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 new guidelines for modifier 25?
Do not use modifier 25 by a physician other than the physician performing the procedure or physician of the same specialty in the same group practice. Do not use modifier 25 when documentation does not support a significant, separately identifiable E/M service.
What is the CPT code 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.”
What is an example of a CPT code?
Here are some examples of CPT codes: 99397 can be used for a preventive exam if you are over age 65. 90658 can be used for the administration of a flu shot. 90716 can be used for the administration of the chickenpox vaccine (varicella).
Can you use modifier 25 with Medicare?
The Centers for Medicare & Medicaid Services (CMS) requires that modifier 25 be used only on claims for E/M services and only when the E/M service is provided by the same physician on the same day as another procedure or service.
What is CPT code 57800?
The Current Procedural Terminology (CPT®) code 57800 as maintained by American Medical Association, is a medical procedural code under the range - Manipulation Procedures on the Cervix Uteri.
What are the documentation requirements for CPT 88305?
Detailed documentation should include the identification of the patient, date of service, procedures performed, diagnosis, and any additional information relevant to the case. Healthcare providers should ensure that their documentation is complete, legible, and compliant with coding and billing regulations.
What is a HCPCS modifier?
A medical coding modifier is two characters (letters or numbers) appended to a CPT® or HCPCS Level II code. The modifier provides additional information about the medical procedure, service, or supply involved without changing the meaning of the code.
How can you tell the difference between a CPT code and a HCPCS code?
CPT codes are entirely numeric and consist of five digits. HCPCS codes are alphanumeric, which means they use both numbers and letters. You'll always see a letter followed by four numbers. These structures make it easy to differentiate between an HCPCS code vs.
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.
Are CPT codes included as HCPCS codes?
HCPCS is divided into 2 main subsystems — Level I and Level II. HCPCS Level I: Comprised of Current Procedural Terminology (CPT®), a numeric coding system maintained by the American Medical Association (AMA).
How are modifiers shown in CPT?
The most common CPT modifiers are nominated by letters or numbers. For example, the modifier -22 indicates increased services, while -52 means reduced fees. Other modifiers include -59 for distinct procedural service, -95 for telehealth, and -96 -97 for habilitative and rehabilitative services, respectively.
When to use HCPCS code?
Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes such as drugs and biologicals, or durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) used in outpatient settings such as hospital outpatient ...