Does CPT 99396 need a modifier?

Per CCI the 99495 or 99496 cannot have a modifier 25 appended, which may be a hint that it is intended to be billed alone. But a 99396 for example can take a modifier 25. So the combination 99396-25 and 99495 may well be acceptable.

Does modifier 25 affect reimbursement?

Currently, if a claim is received by CMS that includes an E&M service with a Modifier 25 and a procedure, both the E&M and the procedure are reimbursed at 100 percent of the allowed amount. …

What is the correct use of modifier 25?

Modifier 25 is used to identify a separate and significant identifiable Evaluation and Management (E/M) service when performed by the same physician or other qualified health care professional on the same day of a procedure or other service.

What are the guidelines for modifier 25?

CPT guidelines define the 25 modifier as “significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service.” In other words, modifier 25 reports that the physician performed an exam which qualified as significantly separate from any other…

What is Medicare modifier 25?

The Modifier 25 is defined as a significant, separately identifiable Evaluation and Management (E/M) service by the same physician of other health qualified health care professional on the same day of a procedure or other service. Medicare defines same physician as physicians in the same group practice who are of the same specialty.

What is modifier code 25?

Modifier 25. Modifier 25 is used to identify a separate and significant identifiable Evaluation and Management (E/M) service when performed by the same physician or other qualified health care professional on the same day of a procedure or other service. This means that on a day a service or procedure is performed,…