AMA CPT® Assistant - 2023 Issue 3 (March)
Reporting CPT Modifier 25 (March 2023)
March 2023 pages 1-12 Reporting CPT Modifier 25 A modifier provides the means to report or to indicate that a performed service or procedure was altered by some specific circumstance but not changed in its definition or code. Modifiers also enable health care professionals to effectively respond to payment-policy requirements established by other entities. These modifiers and their definitions are listed in Appendix A of the Current Procedural Terminology (CPT®) 2023 code set. 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...
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Article Overview
This article explains the scope of CPT modifier 25 within the 2023 CPT code set and reviews the general circumstances in which it is addressed. It is aimed at coders, billing staff, and clinicians who need to understand the article’s coverage of evaluation and management reporting considerations, documentation expectations, and example scenarios across several specialties and service types.
Why This Topic Matters
Modifier 25 is frequently misunderstood, and this article helps readers gauge whether the premium content is relevant to E/M reporting questions, same-day services, and documentation review.
Article Sections
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March 2023 pages 1-12
Publication information for the article and the scope of the issue in which it appears.
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Appropriate Use
General discussion of the modifier’s purpose and the broad circumstances addressed in the article.
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Considerations
Broad reporting considerations tied to evaluation and management services, documentation, and same-day service scenarios.
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Use Examples
A series of illustrative scenarios showing the kinds of encounters and service combinations discussed in the article.
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Summary
A brief recap of the main themes covered in the article.
What You Will Learn
- The general purpose of CPT modifier 25 within the 2023 CPT code set
- The documentation themes associated with same-day evaluation and management services
- The kinds of service combinations and specialties discussed in the article
- The role of examples in illustrating reporting considerations for modifier 25
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Physicians and other qualified health care professionals
- Compliance and revenue cycle teams
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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