Use of Modifier 25

Blue Cross Blue Shield of North Dakota (BCBSND) would like to remind providers of the appropriate use of modifier 25.

The Current Procedural Terminology (CPT)® manual defines modifier 25 as a “Significant, Separately Identifiable Evaluation and Management Service (E&M) by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service.”

Modifier 25 is not to be used in situations when the services provided are part of the usual pre/post care related to the procedure(s). Modifier 25 represents that the E&M service was performed for reasons unrelated to other procedure(s) performed on the same day.

When a preventive E&M and another E&M service with modifier 25 are submitted for the same date of service, BCBSND will consider only the preventive E&M. The remaining E&M with the modifier 25 will be denied as provider liable.

To verify that you are using modifier 25 correctly, please review the CPT® manual as well as other coding resources.