tci Part B Insider - 2014 Issue 23

Modifiers: This Payer Now Rejects Most Modifier 25 Claims

Navigate the modifier maze with quick advice. You’ve followed the modifier 25 guidance, double- and triple-checked the CCI edits, and triumphantly append modifier 25 to your E/M code, awaiting payment for both a procedure and an E/M service—only to find a denial on your desk a few days later. Unfortunately, this scenario is becoming quite common, with yet another payer jumping on the “no extra modifier 25 pay” bandwagon. Background: Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure...

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