Modifier 25 Guidelines for E/M Services

This guide outlines the requirements for using Modifier 25 in medical documentation, specifically for evaluation and management (E/M) services. Modifier 25 indicates that an E/M service is significant and separately identifiable from other services performed on the same date by the same healthcare provider. The document specifies that Modifier 25 can only be appended to certain CPT codes located in the E/M section of the AMA CPT manual and E/M-specific codes in the Medicine section. It details the conditions under which Modifier 25 is appropriate, emphasizing the need for clear documentation to support separate reporting. The guide also explains that claims submitted with Modifier 25 are subject to review during the initial adjudication process to ensure appropriate billing. Additionally, it provides information on how to dispute claims denied due to inappropriate use of Modifier 25, including the necessary documentation for dispute requests.