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BC Advantage - 2023 Issue 6

Defining Modifier 25

You may be thinking, "Really, Pam? Are we talking about modifier 25 again?!"Yes! Considering the recent uproar caused by one payer's plan to implement a policy requiring prepayment review of documentation for all visits billed with 99212-99215, modifier 25, and a minor procedure, it is clear there is still a need to discuss this often-misused modifier.Although we may not like that payers are creating policies about claims reported with modifier 25 – such as reducing or denying payment – or, like the previously mentioned policy, requiring documentation to be sent with these claims, we must consider...

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