Wiki 97001 & 97002 modifier 25 vs 59

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amsmith22

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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
 
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.
 
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.
 
97001

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