Notification

Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service


Notification Issue Date: 12/31/2019



Policy Attachment



Attachment to Policy # 03.00.06r


Attachment:A

Policy #:03.00.06r

Description:E&M codes appended with modifier 25 should be reimbursed at 50% of the applicable fee schedule amount when submitted on the same date of service, by the same professional provider or other qualified health care provider, as a minor procedure.

Title:Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



The E&M codes listed in Table 1 below are reimbursed at 50 percent of the applicable fee schedule amount when appended with modifier 25 and submitted on the same date of service, by the same professional provider or other qualified health care provider, as a minor procedure. A list of minor procedure codes is found in Table 2.

Table 1. E&M Codes

E&M Code
92002
92004
92012
92014
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99217
99218
99219
99220
99224
99225
99226
99281
99282
99283
99284
99285
99318
99324
99325
99326
99327
99328
99334
99335
99336
99341
99342
99343
99344
99345
99347
99348
99349
99350
99381
99382
99383
99384
99385
99386
99387
99391
99392
99393
99394
99395
99396
99397
99401
99402
99403
99404
99411
99412
G0101
G0402
G0463
S0610
S0612
S0613
G0438
G0439
G0380
G0381
G0382
G0383
G0384


The problem-focused E&M codes listed above in Table 1 are reimbursed at 50 percent of the applicable fee schedule amount when appended with modifier 25 and submitted on the same date of service, by the same professional provider or other qualified health care provider, as the minor procedures listed in Table 2.

Table 2. Minor Procedures

Minor procedure codes

G0104
G0105
G0121
G0127
G0168
G0268
G0276
G0341
G0429
G0455
G0516
G0517
G0518
G0460
0479T
0481T
0483T
0484T
0489T
0490T
0491T
0499T
10030
10035
10040
10060
10061
10080
10081
10120
10121
10140
10160
10180
11000
11004
11005
11006
11010
11011
11012
11042
11043
11044
11055
11056
11057
11102
11104
11106
11200
11300
11301
11302
11303
11305
11306
11307
11308
11310
11311
11312
11313
11400
11401
11402
11403
11404
11406
11420
11421
11422
11423
11424
11426
11440
11441
11442
11443
11444
11446
11600
11601
11602
11603
11604
11606
11620
11621
11622
11623
11624
11626
11640
11641
11642
11643
11644
11646
11719
11720
11721
11730
11740
11750
11755
11760
11762
11765
11770
11900
11901
11920
11921
11950
11951
11952
11954
11976
11980
12001
12002
12004
12005
12006
12007
12011
12013
12014
12015
12016
12017
12018
12020
12021
12031
12032
12034
12035
12036
12037
12041
12042
12044
12045
12046
12047
12051
12052
12053
12054
12055
12056
12057
13100
13101
13120
13121
13131
13132
13151
13152
15002
15004
15040
15271
15273
15275
15277
15775
15776
15786
15824
15825
15826
15828
15829
15851
15852
15860
15876
15877
15878
15879
16000
16020
16025
16030
16035
17000
17004
17110
17111
17250
17260
17261
17262
17263
17264
17266
17270
17271
17272
17273
17274
17276
17280
17281
17282
17283
17284
17286
17311
17313
17340
17360
17380
19000
19030
19081
19083
19085
19100
19101
19105
19281
19283
19285
19287
19296
19298
19396
20100
20101
20102
20103
20200
20205
20206
20220
20225
20240
20245
20250
20251
20500
20501
20520
20525
20526
20527
20550
20551
20552
20553
20555
20600
20604
20605
20606
20610
20611
20612
20615
20650
20660
20665
20670
20697
20900
20902
20950
20974
20975
20979
20982
20983
21076
21085
21116
21310
21315
21320
21355
21356
21480
21550
21811
21812
21813
21920
22505
22510
22511
22513
22514
22526
23030
23031
23065
23330
23350
23700
23930
23931
24065
24200
24220
24640
25065
25246
26010
26011
26341
27040
27086
27093
27095
27096
27197
27198
27250
27256
27257
27275
27323
27369
27570
27605
27606
27613
27648
27860
28001
28002
28190
28630
28635
28636
28660
28665
28666
29000
29010
29015
29035
29040
29044
29046
29049
29055
29058
29065
29075
29085
29086
29105
29125
29126
29130
29131
29200
29240
29260
29280
29305
29325
29345
29355
29358
29365
29405
29425
29435
29440
29445
29450
29505
29515
29520
29530
29540
29550
29580
29581
29584
29700
29705
29710
29720
29730
29740
29750
30000
30020
30100
30110
30140
30200
30210
30220
30300
30310
30560
30801
30802
30901
30903
30905
30906
30930
31000
31002
31231
31233
31235
31237
31238
31239
31240
31241
31253
31254
31255
31256
31257
31259
31267
31276
31287
31288
31290
31291
31292
31293
31294
31295
31296
31297
31298
31500
31502
31505
31510
31511
31512
31513
31515
31520
31525
31526
31527
31528
31529
31530
31531
31535
31536
31540
31541
31545
31546
31560
31561
31570
31571
31572
31573
31574
31575
31576
31577
31578
31579
31600
31601
31603
31605
31612
31615
31622
31623
31624
31625
31626
31628
31629
31630
31631
31634
31635
31636
31638
31640
31641
31643
31645
31646
31647
31648
31652
31653
31660
31661
31717
31720
31725
31730
32400
32405
32550
32551
32552
32553
32554
32555
32556
32557
32560
32561
32562
32601
32604
32606
32607
32608
32609
32960
32994
32997
32998
33010
33011
33210
33211
33224
33226
33285
33286
33289
33340
33361
33362
33363
33364
33365
33366
33477
33889
33891
33951
33952
33953
33954
33955
33956
33957
33958
33959
33962
33963
33964
33965
33966
33967
33968
33969
33970
33973
33984
33985
33986
33988
33989
34812
36002
36005
36200
36215
36216
36217
36221
36222
36223
36224
36225
36226
36246
36247
36251
36252
36253
36254
36465
36466
36468
36470
36471
36473
36475
36478
36481
36482
36500
36510
36511
36512
36513
36514
36516
36522
36555
36556
36557
36558
36560
36561
36563
36565
36566
36568
36569
36570
36571
36572
36573
36575
36576
36578
36580
36581
36582
36583
36584
36585
36589
36590
36595
36596
36597
36598
36620
36625
36640
36660
36680
36800
36810
36815
36860
36861
36901
36902
36903
36904
36905
36906
37182
37183
37184
37187
37188
37191
37192
37193
37197
37200
37211
37212
37213
37214
37220
37221
37224
37225
37226
37227
37228
37229
37230
37231
37236
37238
37241
37242
37243
37244
37246
37248
37609
38200
38205
38206
38230
38232
38242
38243
38300
38500
38505
38510
38570
38571
38572
38573
38790
38792
39401
39402
40490
40800
40801
40804
40805
40806
40808
40810
40812
40820
40830
40831
41000
41005
41010
41019
41100
41105
41108
41110
41115
41250
41251
41252
41530
41800
41805
41806
41820
41821
41822
41825
41826
41828
41830
41850
41870
42000
42100
42104
42106
42160
42180
42182
42280
42281
42300
42310
42320
42330
42400
42405
42550
42650
42660
42700
42720
42800
42804
42806
42808
42809
42900
42960
43191
43192
43193
43194
43195
43196
43197
43198
43200
43201
43202
43204
43205
43206
43210
43211
43212
43213
43214
43215
43216
43217
43220
43226
43227
43229
43231
43232
43233
43235
43236
43237
43238
43239
43240
43241
43242
43243
43244
43245
43246
43247
43248
43249
43250
43251
43252
43253
43254
43255
43257
43259
43260
43261
43262
43263
43264
43265
43266
43270
43274
43275
43276
43277
43278
43450
43453
43460
43752
43753
43754
43755
43756
43757
43761
43762
43763
44100
44360
44361
44363
44364
44365
44366
44369
44370
44372
44373
44376
44377
44378
44379
44380
44381
44382
44384
44385
44386
44388
44389
44390
44391
44392
44394
44401
44402
44403
44404
44405
44406
44407
44408
44500
45005
45300
45303
45305
45307
45308
45309
45315
45317
45320
45321
45327
45330
45331
45332
45333
45334
45335
45337
45338
45340
45341
45342
45346
45347
45349
45350
45378
45379
45380
45381
45382
45384
45385
45386
45388
45389
45390
45391
45392
45393
45398
45520
45900
45905
45910
45915
45990
46020
46030
46050
46080
46083
46220
46221
46230
46320
46500
46505
46600
46601
46604
46606
46607
46608
46610
46611
46612
46614
46615
46706
46754
46900
46910
46916
46917
46922
46924
46940
46942
47000
47382
47383
47490
47531
47532
47533
47534
47535
47536
47537
47538
47539
47540
47541
47552
47553
47554
47555
47556
48102
49082
49083
49084
49180
49185
49320
49321
49322
49324
49325
49400
49405
49406
49407
49411
49418
49421
49422
49423
49424
49427
49428
49429
49436
49440
49441
49442
49446
49450
49451
49452
49460
49465
50200
50382
50384
50385
50386
50387
50389
50390
50391
50396
50430
50431
50432
50433
50434
50435
50436
50437
50551
50553
50555
50557
50561
50570
50572
50574
50575
50576
50580
50592
50593
50684
50686
50688
50690
50693
50694
50695
50951
50953
50955
50957
50961
50970
50972
50974
50976
50980
51100
51101
51102
51600
51605
51610
51700
51701
51702
51703
51705
51710
51715
51720
51725
51726
51727
51728
51729
51792
52000
52001
52005
52007
52010
52204
52214
52224
52234
52235
52240
52250
52260
52265
52270
52275
52276
52277
52281
52282
52283
52285
52287
52290
52300
52301
52305
52310
52315
52317
52318
52320
52325
52327
52330
52332
52334
52341
52342
52343
52344
52345
52346
52351
52352
52353
52354
52355
52356
52402
52441
53000
53020
53025
53060
53200
53260
53265
53270
53275
53600
53601
53605
53620
53621
53660
53661
53665
53855
54000
54001
54015
54050
54055
54056
54057
54060
54065
54100
54105
54150
54160
54161
54162
54163
54164
54200
54220
54230
54231
54235
54240
54250
54450
54500
54505
54620
54700
54800
55000
55100
55300
55700
55705
55706
55870
55874
55876
55920
56405
56420
56440
56441
56442
56501
56515
56605
56700
56740
56800
56810
56820
56821
57000
57020
57022
57023
57061
57065
57100
57105
57130
57135
57150
57155
57156
57160
57170
57180
57400
57410
57415
57420
57421
57452
57454
57455
57456
57460
57461
57500
57505
57510
57511
57513
57558
57800
58100
58120
58301
58321
58322
58323
58340
58345
58350
58353
58356
58555
58558
58559
58560
58561
58562
58563
58615
58661
58970
58974
58976
59000
59001
59012
59015
59020
59025
59030
59070
59072
59074
59076
59160
59200
59300
59320
59325
59350
59840
59841
59866
59871
60000
60100
60300
61000
61001
61020
61026
61050
61055
61070
61107
61210
61623
61624
61626
61640
61645
61650
61888
62194
62263
62264
62267
62268
62269
62270
62272
62273
62280
62281
62282
62284
62290
62291
62302
62303
62304
62305
62320
62321
62322
62323
62324
62325
62326
62327
62350
62355
62360
62361
62362
62365
63610
63650
63661
63663
63685
63688
64400
64402
64405
64408
64410
64413
64415
64416
64417
64418
64420
64421
64425
64430
64435
64445
64446
64447
64448
64449
64450
64455
64461
64463
64479
64483
64486
64487
64488
64489
64490
64493
64505
64510
64517
64520
64530
64553
64555
64561
64566
64585
64590
64595
64600
64605
64610
64611
64612
64615
64616
64617
64620
64630
64632
64633
64635
64640
64642
64644
64646
64647
64650
64653
64680
64681
64795
65205
65210
65220
65222
65270
65410
65430
65435
65778
65779
65800
65855
66020
66030
66761
67028
67101
67105
67221
67227
67228
67345
67346
67415
67500
67505
67515
67700
67710
67715
67800
67801
67805
67810
67820
67825
67830
67840
67850
67875
67930
67938
68020
68040
68100
68110
68115
68135
68200
68371
68400
68420
68440
68510
68525
68530
68705
68760
68761
68801
68810
68811
68815
68816
68840
68850
69000
69005
69020
69100
69105
69200
69205
69209
69210
69220
69222
69420
69421
69424
69433
69436
69540
69610
69801
77778
77789
90867
90868
90869
90870
90901
90911
90935
90937
90945
90947
90997
91010
91020
91022
91030
91034
91035
91037
91038
91040
91065
91117
91122
92502
92511
92920
92924
92928
92933
92937
92941
92943
92950
92953
92960
92961
92970
92971
92975
92997
93451
93452
93453
93454
93455
93456
93457
93458
93459
93460
93461
93503
93505
93530
93531
93532
93533
93580
93581
93582
93583
93590
93591
93600
93602
93603
93610
93612
93615
93616
93618
93619
93620
93624
93631
93640
93641
93642
93644
93650
93653
93654
93656
93660
93724
93797
93798
96405
96406
96440
96450
96573
96574
96920
96921
96922
97597
98925
98926
98927
98928
98929
98940
98941
98942
99170

Version Effective Date: 04/15/2020
Version Issued Date: 04/15/2020
Version Reissued Date: N/A



2017 AmeriHealth.