Health Information Management

Tip: Know appropriate codes for use with modifier -25

APCs Insider, June 11, 2010

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According to CMS, you may append modifier -25 only to E/M service codes within the following ranges:

  • 92002–92014 (ophthalmological services)
  • 99201–99215 (office or outpatient services)
  • 99281–99285 (ED services)
  • 99291 (critical care services)
  • 99241–99245 (office or other outpatient consultations)

You also may use modifier -25 with HCPCS codes G0101 (cervical or vaginal cancer screening; pelvic and clinical breast examination) and G0175 (scheduled interdisciplinary team conference [minimum of three exclusive of patient care nursing staff] with patient present).

The same physician/practitioner doesn’t need to perform the procedure and the E/M service for modifier -25 to apply in the facility setting. What is important is that the same facility provided the procedure and the E/M service.

This tip was adapted from “Modifier -25: Is that E/M service really above and beyond the norm?” in the June issue of Briefings on APCs.



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