# Modifier 25 and XXX



## sstep (Mar 21, 2014)

Good Morning

I am looking for information and clarification on whether an E/M code needs to be billed with modifier 25 when billing with a procedure code with an XXX global period-specifically 93970 and 93971.  Per Medicare's National Correct Coding Initiative Policy Manual it does state that with most xxx procedures, the physician may perform an E&M service on the same date of service which may be reported by appending modifier 25 to the E&M code.  I have many people telling me differently, that no modifier 25 is needed on the E&M code (although I am trying to find that in writing).  Also, when putting these codes through the NCCI edits, it states that no modifier is needed with the E&M code when billing with 93970 or 93971.  Does anyone have any information on this?  I appreciate your help!  Thank you


----------



## JesseL (Mar 23, 2014)

sstep said:


> Good Morning
> 
> I am looking for information and clarification on whether an E/M code needs to be billed with modifier 25 when billing with a procedure code with an XXX global period-specifically 93970 and 93971.  Per Medicare's National Correct Coding Initiative Policy Manual it does state that with most xxx procedures, the physician may perform an E&M service on the same date of service which may be reported by appending modifier 25 to the E&M code.  I have many people telling me differently, that no modifier 25 is needed on the E&M code (although I am trying to find that in writing).  Also, when putting these codes through the NCCI edits, it states that no modifier is needed with the E&M code when billing with 93970 or 93971.  Does anyone have any information on this?  I appreciate your help!  Thank you



I would just put the modifer 25 on the E/M to be on the safe side.  Even though it's said modifier 25 is not needed, some carriers will deny it without it.


----------



## MnTwins29 (Mar 24, 2014)

But be careful about adding -25 to everything.  Payers that don't always require it, such as Medicare, will see overuse of this modifier as fraudulent billing.


----------



## dianakayf (Feb 16, 2015)

*Modifier 25 on e&m with 93970*

Doesn't matter if you put the 25 or not for Humana - they will deny it on any of their Medicare products because they know there is nothing you can do.  I have appealed several (for the 16. for a nurse visit).  They have paid a few.  One Humana rep even called and told me this was an incorrect edit but they continue to deny them even with Medical records.  Just another way to steal money from providers.  They don't deny them if they go to copay or deductible
They get paid a lump sum for these Medicare Advantage patients and the less they pay out the more they keep in their pockets.  Traditional Medicare does not want/require a 25 modifier on E&M with ultrasound.  Does anyone know of a place to report this?????  I have not found one.
Diana Franklin, CMRS, CPC


----------



## mcpalmeter (Oct 6, 2016)

I would never append a 25 modifier to a nurse visit on same day as an XXX procedure.  The supervision of the staff is inherent in the XXX procedure so there is no additional expense for the physician to report.


----------



## ceejai7 (Apr 29, 2019)

*Info On Modifier 25 & XXX*

https://cgsmedicare.com/partb/pubs/news/2012/0512/cope18823.html


----------

