Modifier 25 and 59 documentation checklist

A session-only checklist for confirming that documentation supports modifier 25 or 59 before claim submission.

Updated July 20, 2026

Use this session-only checklist to confirm documentation supports modifier 25 or 59 before claim submission. These modifiers assert that a separately identifiable or distinct service was performed; the medical record, current NCCI edits, and payer policy remain the controlling sources.

Progress

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Confirm a separate session or encounter is documentedFor modifier 25, verify the E/M service occurred on the same day as a procedure but represented a distinct encounter; for modifier 59, confirm a separate session or encounter supports the distinct service.Verify medical necessity for both servicesThe record must support that each service was medically necessary on its own, not merely incidental to the other.Confirm the E/M is above usual pre- or post-operative care (modifier 25)When an E/M is billed with a procedure on the same day, the documented E/M must exceed the evaluation included in the procedure's global package.Confirm different anatomic site or separate session (modifier 59)For modifier 59, the documentation must show a different anatomic site, a separate encounter, or a distinct service that an NCCI edit would otherwise bundle.Verify NCCI edit status allows the modifierCheck the current NCCI edit indicator for the code pair; some edits are not separable by modifier and require a different coding approach.Check documentation supports a distinct serviceThe note must describe the distinct service with enough specificity that an auditor can see why the modifier applies — vague or templated entries do not.Confirm the correct code pairing and modifier positionVerify the CPT/HCPCS codes, the modifier placement, and any unit counts against the documented service and the applicable edit.

Use this checklist safely

This tool does not provide coding advice and stores no selections. Verify against current NCCI edits and payer policy.

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