Quick Facts
Status
25
Modifier 25
Unrelated Evaluation and Management Service During a Postoperative Period
Active
Global Period
Same-Day Procedure
Modifier
25
Applies To
E/M Services
Category
Use With
Evaluation and Management
CPT Codes
What is Modifier 25?
Modifier 25 is appended to an evaluation and management (E/M) service when the same physician or qualified healthcare professional performs a significant, separately identifiable E/M service on the same day as another procedure or service.
The modifier indicates that the evaluation went beyond the work normally included in the procedure and may qualify for separate reimbursement when properly documented.
When to Use
A patient requires a medically necessary E/M service in addition to a minor procedure.
A new complaint is evaluated during the same visit.
The physician performs additional history, examination, and medical decision making.
The E/M service is separate from the procedure performed.
Documentation Requirements
Document a separately identifiable E/M service.
Support the medical necessity of the office visit.
Include appropriate history, examination, and medical decision making.
Clearly distinguish the E/M service from the procedure.
Maintain documentation supporting separate reimbursement.
Examples
Example 1
A patient presents with shoulder pain. After a complete evaluation, the physician diagnoses bursitis and performs a corticosteroid injection during the same visit. Because the evaluation was significant and separately identifiable, Modifier 25 may be appended to the E/M service.
Example 2
A patient is evaluated for an infected ingrown toenail. Following the examination, the physician performs a partial nail removal. The office visit included additional medical decision making beyond the procedure itself, making Modifier 25 appropriate.
Billing Tips
Only append Modifier 25 to eligible E/M services.
Do not use Modifier 25 for routine pre-procedure evaluations.
Ensure documentation supports a separate E/M service.
Verify payer-specific billing guidelines.
Report both the procedure and E/M service with the appropriate CPT codes.
Common Denial Reasons
Documentation does not support a separate E/M service.
Modifier appended to the procedure instead of the E/M code.
The evaluation is considered part of the minor procedure.
Medical necessity is not clearly documented.
Insufficient documentation of the office visit.
Related Modifiers
Modifier 24
Unrelated E/M Service During the Postoperative Period
Modifier 57
Decision for Surgery
Modifier 59
Distinct Procedural Service
Modifier 79
Unrelated Procedure During the Postoperative Period
Learn More About Modifier 25
Need more than a quick overview?
CPTCodeGuide provides a concise reference for Modifier 25, but some coding situations require more detailed guidance. Visit ModifierLookup.com for comprehensive billing examples, documentation requirements, payer guidance, denial scenarios, coding comparisons, and frequently asked questions.
