Notification



Notification Issue Date:



Policy Attachment

Attachment to Policy # MA03.003g


Attachment:A

Policy #:MA03.003g

Description:E&M codes appended with modifier 25 should be reimbursed at 50 percent of the applicable fee schedule amount when submitted on the same date of service, by the same professional provider or other qualified health care provider, as a minor procedure.

Title:Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.



The E&M codes listed in Table 1 below are reimbursed at 50 percent of the applicable fee schedule amount when appended with modifier 25 and submitted on the same date of service, by the same professional provider or other qualified health care provider, as a minor procedure. A list of minor procedure codes is found in Table 2.

Table 1. E&M Codes

E&M Code
92002
92004
92012
92014
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99217
99218
99219
99220
99224
99225
99226
99281
99282
99283
99284
99285
99318
99324
99325
99326
99327
99328
99334
99335
99336
99341
99342
99343
99344
99345
99347
99348
99349
99350
99381
99382
99383
99384
99385
99386
99387
99391
99392
99393
99394
99395
99396
99397
99401
99402
99403
99404
99411
99412
G0101
G0402
G0463
S0610
S0612
S0613
G0438
G0439
G0380
G0381
G0382
G0383
G0384


The problem-focused E&M codes listed above in Table 1 are reimbursed at 50 percent of the applicable fee schedule amount when appended with modifier 25 and submitted on the same date of service, by the same professional provider or other qualified health care provider, as the minor procedures listed in Table 2.

Table 2. Minor Procedures


0479T158282863031646371844325347552530606162668400
0481T158292863531647371874325447553532006164068420
0483T158512863631648371884325547554532606164568440
0484T158522866031652371914325747555532656165068510
0489T158602866531653371924325947556532706188868525
0490T158762866631660371934326048102532756219468530
0491T158772900031661371974326149013536006226368705
0499T158782901031717372004326249014536016226468760
10030158792901531720372114326349082536056226768761
10035160002903531725372124326449083536206226868801
10040160202904031730372134326549084536216226968810
10060160252904432400372144326649180536606227068811
10061160302904632405372204327049185536616227268815
10080160352904932550372214327449320536656227368816
10081170002905532551372244327549321538556228068840
10120170042905832552372254327649322540006228168850
10121171102906532553372264327749324540016228269000
10140171112907532554372274327849325540156228469005
10160172502908532555372284345049400540506229069020
10180172602908632556372294345349405540556229169100
11000172612910532557372304346049406540566230269105
11004172622912532560372314375249407540576230369200
11005172632912632561372364375349411540606230469205
11006172642913032562372384375449418540656230569209
11010172662913132601372414375549421541006232069210
11011172702920032604372424375649422541056232169220
11012172712924032606372434375749423541506232269222
11042172722926032607372444376149424541606232369420
11043172732928032608372464376249427541616232469421
11044172742930532609372484376349428541626232569424
11055172762932532960376094410049429541636232669433
11056172802934532994377654436049436541646232769436
11057172812935532997377664436149440542006232869540
11102172822935832998382004436349441542206232969610
11104172832936533016382054436449442542306235069801
11106172842940533017382064436549446542316235577778
11200172862942533018382304436649450542356236077789
11300173112943533019382324436949451542406236190867
11301173132944033210382424437049452542506236290868
11302173402944533211382434437249460544506236590869
11303173602945033224383004437349465545006361090870
11305173802950533226385004437650200545056365090901
11306190002951533285385054437750382546206366190912
11307190302952033286385104437850384547006366390935
11308190812953033289385704437950385548006368590937
11310190832954033340385714438050386550006368890945
11311190852955033361385724438150387551006440090947
11312191002958033362385734438250389553006440590997
11313191012958133363387904438450390557006440891010
11400191052958433364387924438550391557056441591020
11401192812970033365394014438650396557066441691022
11402192832970533366394024438850430558706441791030
11403192852971033477404904438950431558746441891034
11404192872972033889408004439050432558766442091035
11406192962973033891408014439150433559206442191037
11420192982974033951408044439250434564056442591038
11421193962975033952408054439450435564206443091040
11422201003000033953408064440150436564406443591065
11423201013002033954408084440250437564416444591117
11424201023010033955408104440350551564426444691122
11426201033011033956408124440450553565016444792502
11440202003014033957408204440550555565156444892511
11441202053020033958408304440650557566056444992920
11442202063021033959408314440750561567006445092924
11443202203022033962410004440850570567406445192928
11444202253030033963410054450050572568006445492933
11446202403031033964410104500550574568106445592937
11600202453056033965410194530050575568206446192941
11601202503080133966411004530350576568216446392943
11602202513080233967411054530550580570006447992950
11603205003090133968411084530750592570206448392953
11604205013090333969411104530850593570226448692960
11606205203090533970411154530950684570236448792961
11620205253090633973412504531550686570616448892970
11621205263093033984412514531750688570656448992971
11622205273100033985412524532050690571006449092975
11623205503100233986415304532150693571056449392992
11624205513123133988418004532750694571306450592993
11626205523123333989418054533050695571356451092997
11640205533123536002418064533150951571506451793451
11641205553123736005418204533250953571556452093452
11642206003123836200418214533350955571566453093453
11643206043123936215418224533450957571606455393454
11644206053124036216418254533550961571706455593455
11646206063124136217418264533750970571806456193456
11719206103125336221418284533850972574006456693457
11720206113125436222418304534050974574106458593458
11721206123125536223418504534150976574156459093459
11730206153125636224418704534250980574206459593460
11740206503125736225420004534651100574216460093461
11750206603125936226421004534751101574526460593503
11755206653126736246421044534951102574546461093505
11760206703127636247421064535051600574556461193530
11762206973128736251421604537851605574566461293531
11765209003128836252421804537951610574606461593532
11770209023129036253421824538051700574616461693533
11900209503129136254422804538151701575006461793580
11901209743129236465422814538251702575056462093581
11920209753129336466423004538451703575106462493582
11921209793129436468423104538551705575116462593583
11950209823129536470423204538651710575136463093590
11951209833129636471423304538851715575586463293591
11952210763129736473424004538951720578006463393600
11954210853129836475424054539051725581006463593602
11976211163150036478425504539151726581206464093603
11980213103150236481426504539251727583016464293610
11981213153150536482426604539351728583216464493612
11982213203151036500427004539851729583226464693615
11983213553151136510427204552051792583236464793616
12001213563151236511428004590052000583406465093618
12002214803151336512428044590552001583456465393619
12004215503151536513428064591052005583506468093620
12005218113152036514428084591552007583536468193624
12006218123152536516428094599052010583566479593631
12007218133152636522429004602052204585556520593640
12011219203152736555429604603052214585586521093641
12013225053152836556431914605052224585596522093642
12014225103152936557431924608052234585606522293644
12015225113153036558431934608352235585616527093650
12016225133153136560431944622052240585626541093653
12017225143153536561431954622152250585636543093654
12018225263153636563431964623052260586156543593656
12020230303154036565431974632052265586616577893660
12021230313154136566431984650052270589706577993724
12031230653154536568432004650552275589746580093797
12032233303154636569432014660052276589766585593798
12034233503156036570432024660152277590006602096405
12035237003156136571432044660452281590016603096406
12036239303157036572432054660652282590126676196440
12037239313157136573432064660752283590156702896450
12041240653157236575432104660852285590206710196573
12042242003157336576432114661052287590256710596574
12044242203157436578432124661152290590306722196920
12045246403157536580432134661252300590706722796921
12046250653157636581432144661452301590726722896922
12047252463157736582432154661552305590746734597597
12051260103157836583432164670652310590766734698925
12052260113157936584432174675452315591606741598926
12053263413160036585432204690052317592006750098927
12054270403160136589432264691052318593006750598928
12055270863160336590432274691652320593206751598929
12056270933160536595432294691752325593256770098940
12057270953161236596432314692252327593506771098941
13100270963161536597432324692452330598406771598942
13101271973162236598432334694052332598416780099170
131202719831623366204323546942523345986667801G0104
131212725031624366254323647000523415987167805G0105
131312725631625366404323747382523426000067810G0121
131322725731626366604323847383523436010067820G0127
131512727531628366804323947490523446030067825G0168
131522732331629368004324047531523456100067830G0268
150022736931630368104324147532523466100167840G0276
150042757031631368154324247533523516102067850G0341
150402760531634368604324347534523526102667875G0429
152712760631635368614324447535523536105067930G0455
152732761331636369014324547536523546105567938G0460
152752764831638369024324647537523556107068020G0516
152772786031640369034324747538523566110768040
G0517
157752800131641369044324847539524026121068100
G0518
157762800231643369054324947540524416162368110
157862819031645369064325047541530006162468115
15824
37182
43251
53020
68135
15825
37183
43252
53025
68200
15826
68371
Version Effective Date: 01/01/2020
Version Issued Date: 01/06/2020
Version Reissued Date: N/A

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2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.