Modifier 25
Modifier 25 identifies a significant, separately identifiable evaluation and management service performed by the same clinician on the same day as a procedure.
Updated
Modifier 25 is appended to an E/M service code to indicate that, on the same day a procedure was performed, a separate and significant E/M service was also furnished that was above and beyond the usual pre- and post-operative care associated with the procedure.
The E/M service must be medically necessary and documented as a distinct encounter; routine pre-procedure assessment or post-procedure follow-up included in the procedure is not separately billable.
In practice
Billers append modifier 25 to the E/M code when documentation supports a separately identifiable service, helping prevent bundling denials while guarding against unbundling that could trigger payer audits or edits.
Commonly confused with
- Modifier 59: Modifier 59 denotes a distinct procedural service and is not limited to E/M services; modifier 25 applies specifically to E/M services billed on the same day as a procedure.