BC Advantage - 2018 Issue 10

When to Use Modifier 25 and Modifier 57 on Physician Claims

The biggest thing modifiers 25 and 57 have in common is that they both assert that the E/M service should be payable based on documentation within the record showing the procedure should not be bundled into the E/M. After that, the similarities end, and it is important to know the distinctions between these two modifiers. Modifier 25 is used to indicate that a significant, separately identifiable E/M service by the same physician or other qualified health care professional was performed on the same day of the procedure or other service. Modifier 57 is defined as decision for...

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