What does modifier 25 indicate?

Modifier 25 is used to indicate that a significant, separately identifiable evaluation and management (E/M) service was provided on the same day as a procedure or other service. This modifier is particularly important for ensuring that healthcare providers are reimbursed appropriately for their work when they perform both an E/M service and a procedure during the same encounter.

In practical terms, when a provider assesses a patient, performs a thorough evaluation, and identifies a need for an additional procedure within the same visit, they can attach modifier 25 to the E/M code. This signals that the evaluation and management service was not merely part of the procedure but was a distinct and necessary assessment that warranted separate attention and billing. This modifier is crucial in clinical scenarios where the complexity of patient conditions requires both detailed evaluation and intervention.

Using modifier 25 appropriately ensures that providers are not under-compensated for the additional time and resources spent on the patient assessment, reinforcing the significance of thorough patient evaluation.