Some payers ask for modifier 25 on E/Ms with tests

Why This Topic Matters

Billing teams often face payer-specific instructions that may conflict with standard coding guidance. Understanding the difference between general coding guidance and payer rules can help reduce claim denials and support consistent reporting.

Article Sections

1. Payer requests for modifier 25 with diagnostic tests

   Introduces the issue of payer demands for modifier 25 when evaluation and management services are reported with diagnostic testing or other related services. Discusses the broader conflict between payer instructions and standard coding guidance.

2. How coders and practices respond to payer-specific instructions

   Describes how billing staff may handle payer requirements in order to receive payment. Emphasizes the role of written payer policy when local requirements differ from general guidance.

3. Medicare guidance and prior bundling changes

   Summarizes the Medicare-related discussion in the article, including a prior period of bundling edits and the later reversal. Notes the article’s focus on how Medicare’s approach differs from some private payer policies.