Wiki Mod 25 with imms

[HBULLOCK]

I was just informed by my manager that we no longer need to use modifier 25 when billing with immunizations. Has anyone else heard this? Also the use of mod 59 when billing visual acuity is now neccessary? Any thoughts? Thanks alot.

 

[cheermom68]

Each payer may have a different philosophy about the 25 modifier with immunizations, however the last time I looked at the CCI edit, it was still required.

 

[HBULLOCK]

Thanks for the response. We recently joined a new group of practices and their director sent us this information. I'll keep an eye on it.

 

[swilliams2]

mods

We also still use mod 25 with imms, but we do not use mod 59 for vision-with any of the payers.

 

[shellysk8]

CCI Edits

CMS put in the CCI edit for immunization administration codes billed with E&M/Prev Med services effective 1/1/13. There was no provider or payer notification done about the change. Due to great outcry, in March they advised the States/payers that it was up to each State FFS Medicaid agency whether or not they would enforce them for Q1, 2013, in order to allow time for provider education. The plan was to then have them again fully in force Q2. However, many large provider groups were still quite unhappy about the change and pressuring CMS to have these edits removed. I haven't heard anything further yet at this point on a final action by CMS regarding permanent removal or retention of the edits.

Thanks,
Shelly