# Modifier 25 with 36415



## amoore2986 (Mar 14, 2018)

I have a question in regards to 36415 + 25 modifier.  My denial manager is asking me to add the 25 modifier to 36415 for payment on Tricare claims. In all of my studies I have not seen this to be accurate.  Can anyone validate this for me?

Thank you for your advice! It is very much appreciated!


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## devinmajor14 (Mar 14, 2018)

You cannot use modifier 25 with this code.


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## amoore2986 (Mar 14, 2018)

Thank you!  I did not believe so, but I needed some back up!


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## mitchellde (Mar 14, 2018)

Perhaps she meant you need to add a 25 modifier to the E&M code or the 36415 will not be reimbursed.  And that is possibly true with tricare


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## amoore2986 (Mar 14, 2018)

Yes, I believe that is what she meant.  Even if there is no surgical procedure? Thanks in advance for the answer.


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## mitchellde (Mar 14, 2018)

It is probably because the 36415 is in the CPT section for surgical procedures and that is the way Tricare has set their edits.  Anything in the CPT range of 10000-69999 is designated as surgical.


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## amoore2986 (Mar 14, 2018)

Thank you very much.  I will try this on some claims and see what happens. I appreciate your responses. Have a wonderful day!


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