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Pediatric Coding Alert

Modifier 25:

Two Major Payers Change Modifier 25 Policies

Published on Thu Jul 10, 2014

You’ll need a new diagnosis for E/M payment from Tufts. Most pediatric practices use modifier 25 multiple times a day to let insurers know that they deserve separate payment for E/M visits done with procedures—but one payer has cracked down on sending you payment for these services. Background: Modifier 25 (Significant, separately identifiable evaluation and management service by the same [...]
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