Complete Story
07/07/2026
The More You Know: 25 Modifier Resources
25 Modifier Resource Compilation
Appropriate use of the 25 modifier is essential. There has recently been an uptick in payers proposing and / or implementing edits to deny payment of Modifier 25 when billing an evaluation and management (E/M) service with a procedure. They are using incorrect utilization and inadequate documentation to support these edits and denials.
When a procedure and an E&M that is significant in nature and separately identifiable from that procedure are both performed, it is essential that the documentation clearly reflects two separate services with no overlap in work of the E&M and the work of the procedure and that the E&M did not result in a decision to perform the procedure.
