What is the 25 modifier used for?
Asked by: Providenci Hickle | Last update: September 13, 2025Score: 4.3/5 (3 votes)
What is a modifier 25 with example?
Report an E/M service with modifier 25 when a significant and distinct E/M service is indicated even when both services are related to the same diagnosis (e.g., E/M of asthma and in-office spirometry).
When to use 25 and 59 modifiers?
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 inappropriate use of modifier 25?
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.
What is the difference between modifier 25 and 50?
The Modifier 25 is appended to the E/M visit to indicate that there was a separately identifiable E/M on the same day of the procedure. Modifier 50 should be used to report bilateral surgical procedures as a single unit of service.
What is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
What is the 50 modifier used for?
Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).
How much does a modifier 25 reduce a 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 ...
What are the new guidelines for modifier 25?
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.
What is an unnecessary modifier?
A modifier is a word or a group of words which describe, limit, or qualify a subject. There are two kinds of modifiers: nonrestrictive and restrictive. Nonrestrictive modifiers are not essential or not necessary to the meaning of a sentence while restrictive modifiers are necessary to the meaning of the sentence.
How do you use modifier 25 with preventive visit?
Modifier 25 should always be attached to the E/M code. If provided with a preventive medicine visit, it should be attached to the office-based E/M code (99202–99215). The separately billed E/M service must meet documentation requirements for the code level selected.
What is modifier 59 most commonly used for?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
Can you bill both a 25 and 57 modifier?
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.
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.
Are modifiers 25 and 59 interchangeable?
Recently, ACP has received several member inquiries regarding the use of CPT modifiers 59 and 25 in conjunction with evaluation and management (E/M) codes. The two modifiers are very similar, but not interchangeable.
What is modifier 58?
Modifier 58 is defined as a staged or related procedure performed during the postoperative period of the first procedure by the same physician. A new postoperative period begins when the staged procedure is billed.
What is modifier 25 not used for?
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 best modifier?
The best universal modifier is Godly or Demonic. The two modifiers only differ in knockback, a stat that is not considered very useful (or even beneficial) in many situations. The difference in knockback is also negligible enough that Godly and Demonic can be treated as the same modifier.
What are the 5 types of modifiers?
As illustrated below, modifiers in English include adjectives, adverbs, demonstratives, possessive determiners, prepositional phrases, degree modifiers, and intensifiers. Modifiers that appear before the head are called premodifiers, while modifiers that appear after the head are called postmodifiers.
What are examples of modifier 25 use?
Here is an example of an appropriate use of Modifier 25: Example 1: A patient visits the cardiologist for an appointment complaining of occasional chest discomfort during exercise. The patient has a history of hypertension and high cholesterol.
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 does modifier 24 and 25 indicate?
Modifier 24 refers to the evaluation and management services provided to the patient on the day of a surgical procedure unrelated to the procedure itself. Modifier 25 identifies the evaluation and management services as unique services provided on the same day by the same medical professional.
Can modifier 25 be used twice?
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 you bill an office visit with a cast application?
A charge for procedure codes 29000-29590 is allowed only when the casting or strapping is a replacement procedure used during the period of follow-up care. The charge for an office visit is allowed only if significant identifiable further services are provided at the time of the cast application or strapping.
Is modifier 25 needed for immunizations?
Yes, you bill the immunizations separate from the well-child visit, with the -25 on the visit. in fact, if you read the introduction to the Preventive Medicine Services (page 36 in the AMA Professional CPT edition), it states "Vaccine/toxoid products, immunization administrations.....are reported separately".