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Modifier 25

CPT numeric modifiers (AMA · CPT Appendix A)

Modifier 25. Significant, Separately Identifiable E/M on the Same Day as a Procedure — E/M above and beyond the usual pre/post work of a same-day procedure. The single highest-misuse modifier; documentation must establish a service distinct from the procedure's inherent work.

This is a high-denial-risk modifier and a known OIG audit target — append it only when the documentation supports a distinct or separately identifiable service.

Reference only — CPT descriptors are AMA-copyrighted (paraphrased). Payment percentages and acceptance vary by payer; verify against the current CPT/HCPCS files and payer policy.

Related modifiers

22
Increased Procedural Services — work substantially greater than typical. Require…
23
Unusual Anesthesia — general anesthesia used where the procedure usually needs n…
24
Unrelated E/M During a Postoperative Period — same physician provides an E/M unr…
26
Professional Component — bills only the physician's interpretation/supervision p…
27
Multiple Outpatient Hospital E/M Encounters on the Same Date — facility (hospita…
32
Mandated Services — service required by a third party (e.g., a payer-mandated se…
33
Preventive Services — flags an ACA-designated preventive service so commercial p…
47
Anesthesia by Surgeon — surgeon personally provided regional/general anesthesia.…

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