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Notification
Notification Issue Date:
Policy Attachment
Attachment
to Policy #
03.00.06p
Attachment:
A
Policy #:
03.00.06p
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 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
99241
99242
99243
99244
99245
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
0479T
15828
28630
31646
37184
43253
47552
53060
61626
68400
0481T
15829
28635
31647
37187
43254
47553
53200
61640
68420
0483T
15851
28636
31648
37188
43255
47554
53260
61645
68440
0484T
15852
28660
31652
37191
43257
47555
53265
61650
68510
0489T
15860
28665
31653
37192
43259
47556
53270
61888
68525
0490T
15876
28666
31660
37193
43260
48102
53275
62194
68530
0491T
15877
29000
31661
37197
43261
49082
53600
62263
68705
0499T
15878
29010
31717
37200
43262
49083
53601
62264
68760
10030
15879
29015
31720
37211
43263
49084
53605
62267
68761
10035
16000
29035
31725
37212
43264
49180
53620
62268
68801
10040
16020
29040
31730
37213
43265
49185
53621
62269
68810
10060
16025
29044
32400
37214
43266
49320
53660
62270
68811
10061
16030
29046
32405
37220
43270
49321
53661
62272
68815
10080
16035
29049
32550
37221
43274
49322
53665
62273
68816
10081
17000
29055
32551
37224
43275
49324
53855
62280
68840
10120
17004
29058
32552
37225
43276
49325
54000
62281
68850
10121
17110
29065
32553
37226
43277
49400
54001
62282
69000
10140
17111
29075
32554
37227
43278
49405
54015
62284
69005
10160
17250
29085
32555
37228
43450
49406
54050
62290
69020
10180
17260
29086
32556
37229
43453
49407
54055
62291
69100
11000
17261
29105
32557
37230
43460
49411
54056
62302
69105
11004
17262
29125
32560
37231
43752
49418
54057
62303
69200
11005
17263
29126
32561
37236
43753
49421
54060
62304
69205
11006
17264
29130
32562
37238
43754
49422
54065
62305
69209
11010
17266
29131
32601
37241
43755
49423
54100
62320
69210
11011
17270
29200
32604
37242
43756
49424
54105
62321
69220
11012
17271
29240
32606
37243
43757
49427
54150
62322
69222
11042
17272
29260
32607
37244
43761
49428
54160
62323
69420
11043
17273
29280
32608
37246
43762
49429
54161
62324
69421
11044
17274
29305
32609
37248
43763
49436
54162
62325
69424
11055
17276
29325
32960
37609
44100
49440
54163
62326
69433
11056
17280
29345
32994
38200
44360
49441
54164
62327
69436
11057
17281
29355
32997
38205
44361
49442
54200
62350
69540
11102
17282
29358
32998
38206
44363
49446
54220
62355
69610
11104
17283
29365
33010
38230
44364
49450
54230
62360
69801
11106
17284
29405
33011
38232
44365
49451
54231
62361
77778
11200
17286
29425
33210
38242
44366
49452
54235
62362
77789
11300
17311
29435
33211
38243
44369
49460
54240
62365
90867
11301
17313
29440
33224
38300
44370
49465
54250
63610
90868
11302
17340
29445
33226
38500
44372
50200
54450
63650
90869
11303
17360
29450
33285
38505
44373
50382
54500
63661
90870
11305
17380
29505
33286
38510
44376
50384
54505
63663
90901
11306
19000
29515
33289
38570
44377
50385
54620
63685
90911
11307
19030
29520
33340
38571
44378
50386
54700
63688
90935
11308
19081
29530
33361
38572
44379
50387
54800
64400
90937
11310
19083
29540
33362
38573
44380
50389
55000
64402
90945
11311
19085
29550
33363
38790
44381
50390
55100
64405
90947
11312
19100
29580
33364
38792
44382
50391
55300
64408
90997
11313
19101
29581
33365
39401
44384
50396
55700
64410
91010
11400
19105
29584
33366
39402
44385
50430
55705
64413
91020
11401
19281
29700
33477
40490
44386
50431
55706
64415
91022
11402
19283
29705
33889
40800
44388
50432
55870
64416
91030
11403
19285
29710
33891
40801
44389
50433
55874
64417
91034
11404
19287
29720
33951
40804
44390
50434
55876
64418
91035
11406
19296
29730
33952
40805
44391
50435
55920
64420
91037
11420
19298
29740
33953
40806
44392
50436
56405
64421
91038
11421
19396
29750
33954
40808
44394
50437
56420
64425
91040
11422
20100
30000
33955
40810
44401
50551
56440
64430
91065
11423
20101
30020
33956
40812
44402
50553
56441
64435
91117
11424
20102
30100
33957
40820
44403
50555
56442
64445
91122
11426
20103
30110
33958
40830
44404
50557
56501
64446
92502
11440
20200
30140
33959
40831
44405
50561
56515
64447
92511
11441
20205
30200
33962
41000
44406
50570
56605
64448
92920
11442
20206
30210
33963
41005
44407
50572
56700
64449
92924
11443
20220
30220
33964
41010
44408
50574
56740
64450
92928
11444
20225
30300
33965
41019
44500
50575
56800
64455
92933
11446
20240
30310
33966
41100
45005
50576
56810
64461
92937
11600
20245
30560
33967
41105
45300
50580
56820
64463
92941
11601
20250
30801
33968
41108
45303
50592
56821
64479
92943
11602
20251
30802
33969
41110
45305
50593
57000
64483
92950
11603
20500
30901
33970
41115
45307
50684
57020
64486
92953
11604
20501
30903
33973
41250
45308
50686
57022
64487
92960
11606
20520
30905
33984
41251
45309
50688
57023
64488
92961
11620
20525
30906
33985
41252
45315
50690
57061
64489
92970
11621
20526
30930
33986
41530
45317
50693
57065
64490
92971
11622
20527
31000
33988
41800
45320
50694
57100
64493
92975
11623
20550
31002
33989
41805
45321
50695
57105
64505
92997
11624
20551
31231
36002
41806
45327
50951
57130
64510
93451
11626
20552
31233
36005
41820
45330
50953
57135
64517
93452
11640
20553
31235
36200
41821
45331
50955
57150
64520
93453
11641
20555
31237
36215
41822
45332
50957
57155
64530
93454
11642
20600
31238
36216
41825
45333
50961
57156
64553
93455
11643
20604
31239
36217
41826
45334
50970
57160
64555
93456
11644
20605
31240
36221
41828
45335
50972
57170
64561
93457
11646
20606
31241
36222
41830
45337
50974
57180
64566
93458
11719
20610
31253
36223
41850
45338
50976
57400
64585
93459
11720
20611
31254
36224
41870
45340
50980
57410
64590
93460
11721
20612
31255
36225
42000
45341
51100
57415
64595
93461
11730
20615
31256
36226
42100
45342
51101
57420
64600
93503
11740
20650
31257
36246
42104
45346
51102
57421
64605
93505
11750
20660
31259
36247
42106
45347
51600
57452
64610
93530
11755
20665
31267
36251
42160
45349
51605
57454
64611
93531
11760
20670
31276
36252
42180
45350
51610
57455
64612
93532
11762
20697
31287
36253
42182
45378
51700
57456
64615
93533
11765
20900
31288
36254
42280
45379
51701
57460
64616
93580
11770
20902
31290
36465
42281
45380
51702
57461
64617
93581
11900
20950
31291
36466
42300
45381
51703
57500
64620
93582
11901
20974
31292
36468
42310
45382
51705
57505
64630
93583
11920
20975
31293
36470
42320
45384
51710
57510
64632
93590
11921
20979
31294
36471
42330
45385
51715
57511
64633
93591
11950
20982
31295
36473
42400
45386
51720
57513
64635
93600
11951
20983
31296
36475
42405
45388
51725
57558
64640
93602
11952
21076
31297
36478
42550
45389
51726
57800
64642
93603
11954
21085
31298
36481
42650
45390
51727
58100
64644
93610
11976
21116
31500
36482
42660
45391
51728
58120
64646
93612
11980
21310
31502
36500
42700
45392
51729
58301
64647
93615
12001
21315
31505
36510
42720
45393
51792
58321
64650
93616
12002
21320
31510
36511
42800
45398
52000
58322
64653
93618
12004
21355
31511
36512
42804
45520
52001
58323
64680
93619
12005
21356
31512
36513
42806
45900
52005
58340
64681
93620
12006
21480
31513
36514
42808
45905
52007
58345
64795
93624
12007
21550
31515
36516
42809
45910
52010
58350
65205
93631
12011
21811
31520
36522
42900
45915
52204
58353
65210
93640
12013
21812
31525
36555
42960
45990
52214
58356
65220
93641
12014
21813
31526
36556
43191
46020
52224
58555
65222
93642
12015
21920
31527
36557
43192
46030
52234
58558
65270
93644
12016
22505
31528
36558
43193
46050
52235
58559
65410
93650
12017
22510
31529
36560
43194
46080
52240
58560
65430
93653
12018
22511
31530
36561
43195
46083
52250
58561
65435
93654
12020
22513
31531
36563
43196
46220
52260
58562
65778
93656
12021
22514
31535
36565
43197
46221
52265
58563
65779
93660
12031
22526
31536
36566
43198
46230
52270
58615
65800
93724
12032
23030
31540
36568
43200
46320
52275
58661
65855
93797
12034
23031
31541
36569
43201
46500
52276
58970
66020
93798
12035
23065
31545
36570
43202
46505
52277
58974
66030
96405
12036
23330
31546
36571
43204
46600
52281
58976
66761
96406
12037
23350
31560
36572
43205
46601
52282
59000
67028
96440
12041
23700
31561
36573
43206
46604
52283
59001
67101
96450
12042
23930
31570
36575
43210
46606
52285
59012
67105
96573
12044
23931
31571
36576
43211
46607
52287
59015
67221
96574
12045
24065
31572
36578
43212
46608
52290
59020
67227
96920
12046
24200
31573
36580
43213
46610
52300
59025
67228
96921
12047
24220
31574
36581
43214
46611
52301
59030
67345
96922
12051
24640
31575
36582
43215
46612
52305
59070
67346
97597
12052
25065
31576
36583
43216
46614
52310
59072
67415
98925
12053
25246
31577
36584
43217
46615
52315
59074
67500
98926
12054
26010
31578
36585
43220
46706
52317
59076
67505
98927
12055
26011
31579
36589
43226
46754
52318
59160
67515
98928
12056
26341
31600
36590
43227
46900
52320
59200
67700
98929
12057
27040
31601
36595
43229
46910
52325
59300
67710
98940
13100
27086
31603
36596
43231
46916
52327
59320
67715
98941
13101
27093
31605
36597
43232
46917
52330
59325
67800
98942
13120
27095
31612
36598
43233
46922
52332
59350
67801
99170
13121
27096
31615
36620
43235
46924
52334
59840
67805
G0104
13131
27197
31622
36625
43236
46940
52341
59841
67810
G0105
13132
27198
31623
36640
43237
46942
52342
59866
67820
G0121
13151
27250
31624
36660
43238
47000
52343
59871
67825
G0127
13152
27256
31625
36680
43239
47382
52344
60000
67830
G0168
15002
27257
31626
36800
43240
47383
52345
60100
67840
G0268
15004
27275
31628
36810
43241
47490
52346
60300
67850
G0276
15040
27323
31629
36815
43242
47531
52351
61000
67875
G0341
15271
27369
31630
36860
43243
47532
52352
61001
67930
G0429
15273
27570
31631
36861
43244
47533
52353
61020
67938
G0455
15275
27605
31634
36901
43245
47534
52354
61026
68020
G0460
15277
27606
31635
36902
43246
47535
52355
61050
68040
G0516
15775
27613
31636
36903
43247
47536
52356
61055
68100
G0517
15776
27648
31638
36904
43248
47537
52402
61070
68110
G0518
15786
27860
31640
36905
43249
47538
52441
61107
68115
15824
28001
31641
36906
43250
47539
53000
61210
68135
15825
28002
31643
37182
43251
47540
53020
61623
68200
15826
28190
31645
37183
43252
47541
53025
61624
68371
Version Effective Date:
01/01/2019
Version Issued Date:
02/13/2019
Version Reissued Date:
N/A
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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.