# 97001 & 97002 modifier 25 vs 59



## amsmith22 (Jun 25, 2010)

We are having trouble finding documentation to support the use of modifier 25 vs 59 for a physical therapy evaluation or re-evaluation when done on the same day as therapy services which may or may not include ADLs.
My thought process is that 25 is only for physician E&M services and shouldn't be used on therapy or other eval codes.  My co-workers have been using modifier 25 and the payors are accepting the charges and paying them.
Does anybody know where I can go to find out if 25 is actually acceptable coding practice?

Any help or suggestions would be greatly appreciated.

Thanks


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## Herbie Lorona (Jun 28, 2010)

Depending on the CPT codes they probably don't need any modifier. For instance 97001 and 97116 are not bundled and there is no need for a modifier.


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## dballard2004 (Jun 28, 2010)

Modifier 25 does not get apppended to these codes.  This is per CPT Assistant, December 2003.  Modifier 25 is only appended to E/M codes, and codes 97001/97002 are not E/M codes.  If 97001/97002 are reported on the same encounter as other therapy services, then modifier 59 should be appended.


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## amsmith22 (Jun 28, 2010)

thank you dballard! those were my sentiments exactly!


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## ALDO (Oct 3, 2011)

*97001*

Modifier 59 will not pay for your 97001, I've billed it without and got paid by Medicare


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## Lanter (Nov 16, 2011)

evals do not need a modifier however if you do treatment and a re-eval 97002  or 97004 you will need a modifier -59 if you want to get paid and these can only be done every 30 days for WC.


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