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07/01/2026
The More You Know: 25 Modifier Resources
25 Modifier Resource Compilation
Appropriate use of the 25 modifier is essential. There has recently been an uptick in payers proposing and / or implementing edits to deny payment of Modifier 25 when billing an evaluation and management (E/M) service with a procedure. They are using incorrect utilization and inadequate documentation to support these edits and denials.
When a procedure and an E&M that is significant in nature and separately identifiable from that procedure are both performed, the documentation must clearly reflect two separate services with no overlap in work of the E&M and the work of the procedure and that the E&M did not result in a decision to perform the procedure.
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