# Mod 25 g0439



## vjensenbfp (Jan 18, 2018)

Medicare is denying G0438 or G0439 if I put a mod 25 on it when we are also doing a procedure or injection.  Does Medicare not want the MOD25 on a preventative E&M like we do on a 99213 etc??


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## iowagirl77 (Jan 24, 2018)

Modifier 25 is not needed when billed with G0438/G0439 and an injection. This modifier is not even an option for those HCPCS. From what I can find, the reasoning is because the AWV is not a problem-oriented visit so the injection is automatically assumed unrelated. 

Susan


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## kroemer4 (Feb 2, 2018)

*G-Codes and Modifier 25*

Medicare doesn't reimburse for the preventive codes (99381-99397); they are statutorily excluded from coverage and so appending a mod -25 to the charge is pointless. Medicare provides the IPPE/AWV as its "preventive" care as long as the services are rendered with required elements and within specific timeframes (because Medicare would have it no other way). If the patient receives care supported by a 99201-99215, the -25 modifier would be appropriate to append to the E/M. Keep in mind, the documentation must support the IPPE/AWV, any other carve-out G-code for Medicare, and the additional need for an E/M code without double-dipping among elements. Also, Medicare has its own G-codes for a few immunizations, so be sure you are billing via the correct CPT/HCPCS.


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