CPT modifier
Modifier 25: Significant, separate E/M visit on the same day
Modifier 25 is a CPT modifier. In plain terms: An evaluation and management visit on the same day as a procedure or other service, by the same physician, that is significant and separately identifiable from that service.
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- Modifier
- 25
- Type
- CPT (Level I) modifier, maintained by the AMA
- Plain description
- An evaluation and management visit on the same day as a procedure or other service, by the same physician, that is significant and separately identifiable from that service.
- How it is used
- Goes on the E/M code, not the procedure. The record should show work beyond the usual pre- and post-service care for the procedure. A separate diagnosis is not required.
- Claim form
- CMS-1500 item 24D, up to four modifiers per line. 837P SV101-3 to SV101-6.
The CPT descriptor is AMA copyright and is not shown here. The description above is written by Rivvi. Read the CMS guidance linked above for Medicare's rules.
Global surgery period
- 24Unrelated E/M visit in the postoperative period
- 57Decision for surgery
- 58Staged or related procedure in the postoperative period
- 78Unplanned return to the operating room in the postoperative period
- 79Unrelated procedure in the postoperative period
- 54Surgical care only
- 55Postoperative management only
- 56Preoperative management only
- FTUnrelated evaluation and management (E/M) visit on the same day as another E/M visit or during a global procedure (preoperative, postoperative period, or on the same day as the procedure, as applicable). (report when an E/M visit is furnished within the global period but is unrelated, or when one or more additional E/M visits furnished on the same day are unrelated)
Related modifiers
- 24Unrelated E/M visit in the postoperative period
- 57Decision for surgery
- 58Staged or related procedure in the postoperative period
- 78Unplanned return to the operating room in the postoperative period
- 79Unrelated procedure in the postoperative period
- 54Surgical care only
- 55Postoperative management only
- 56Preoperative management only
- FTUnrelated evaluation and management (E/M) visit on the same day as another E/M visit or during a global procedure (preoperative, postoperative period, or on the same day as the procedure, as applicable). (report when an E/M visit is furnished within the global period but is unrelated, or when one or more additional E/M visits furnished on the same day are unrelated)
Related pages
- All CPT and HCPCS modifiersA to Z list
- CMS-1500 claim formModifiers go in item 24D
- Denial code CO-4Modifier missing or does not fit the code
- Denial code CO-182Modifier invalid on the date of service
- Denial code CO-97Included in another service
- Denial code CO-236Procedure or modifier pair not compatible
- HCPCS Level II code lookup
- Denial and remark codes
Questions
What does modifier 25 mean?
Modifier 25 is a CPT modifier. In plain terms: An evaluation and management visit on the same day as a procedure or other service, by the same physician, that is significant and separately identifiable from that service.
Is modifier 25 a CPT or a HCPCS modifier?
25 is a CPT (Level I) modifier. The AMA maintains CPT modifiers. Two-character codes with a letter, such as GT or XU, are HCPCS Level II modifiers from CMS.
Where does modifier 25 go on a claim?
On the CMS-1500 it goes in item 24D next to the procedure code. Each line holds up to four modifiers. On an 837P it goes in SV101-3 to SV101-6.
When is modifier 25 used?
Goes on the E/M code, not the procedure. The record should show work beyond the usual pre- and post-service care for the procedure. A separate diagnosis is not required.
What denial comes back when a modifier is wrong?
A missing or mismatched modifier often comes back as CARC 4. A modifier that was not valid on the date of service comes back as CARC 182. A bundling edit the modifier should have bypassed comes back as CARC 97 or 236.