Reader Question: Some Payers May Want Modifier 25 Despite Add-on Nature

Article Overview

This reader Q&A examines a commercial payer denial related to billing an evaluation and management service with a prolonged services add-on code on the same date of service. It explains the general issue of add-on coding, discusses how payer-specific policy can differ from common expectations, and references CPT guidance and a payer’s prolonged services policy. The article is useful for coders and billers who need to understand payer behavior, documentation expectations, and how to verify policy requirements before resubmitting or appealing similar claims.