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


0479T158282863031646371844325347552530606162668400
0481T158292863531647371874325447553532006164068420
0483T158512863631648371884325547554532606164568440
0484T158522866031652371914325747555532656165068510
0489T158602866531653371924325947556532706188868525
0490T158762866631660371934326048102532756219468530
0491T158772900031661371974326149082536006226368705
0499T158782901031717372004326249083536016226468760
10030158792901531720372114326349084536056226768761
10035160002903531725372124326449180536206226868801
10040160202904031730372134326549185536216226968810
10060160252904432400372144326649320536606227068811
10061160302904632405372204327049321536616227268815
10080160352904932550372214327449322536656227368816
10081170002905532551372244327549324538556228068840
10120170042905832552372254327649325540006228168850
10121171102906532553372264327749400540016228269000
10140171112907532554372274327849405540156228469005
10160172502908532555372284345049406540506229069020
10180172602908632556372294345349407540556229169100
11000172612910532557372304346049411540566230269105
11004172622912532560372314375249418540576230369200
11005172632912632561372364375349421540606230469205
11006172642913032562372384375449422540656230569209
11010172662913132601372414375549423541006232069210
11011172702920032604372424375649424541056232169220
11012172712924032606372434375749427541506232269222
11042172722926032607372444376149428541606232369420
11043172732928032608372464376249429541616232469421
11044172742930532609372484376349436541626232569424
11055172762932532960376094410049440541636232669433
11056172802934532994382004436049441541646232769436
11057172812935532997382054436149442542006235069540
11102172822935832998382064436349446542206235569610
11104172832936533010382304436449450542306236069801
11106172842940533011382324436549451542316236177778
11200172862942533210382424436649452542356236277789
11300173112943533211382434436949460542406236590867
11301173132944033224383004437049465542506361090868
11302173402944533226385004437250200544506365090869
11303173602945033285385054437350382545006366190870
11305173802950533286385104437650384545056366390901
11306190002951533289385704437750385546206368590911
11307190302952033340385714437850386547006368890935
11308190812953033361385724437950387548006440090937
11310190832954033362385734438050389550006440290945
11311190852955033363387904438150390551006440590947
11312191002958033364387924438250391553006440890997
11313191012958133365394014438450396557006441091010
11400191052958433366394024438550430557056441391020
11401192812970033477404904438650431557066441591022
11402192832970533889408004438850432558706441691030
11403192852971033891408014438950433558746441791034
11404192872972033951408044439050434558766441891035
11406192962973033952408054439150435559206442091037
11420192982974033953408064439250436564056442191038
11421193962975033954408084439450437564206442591040
11422201003000033955408104440150551564406443091065
11423201013002033956408124440250553564416443591117
11424201023010033957408204440350555564426444591122
11426201033011033958408304440450557565016444692502
11440202003014033959408314440550561565156444792511
11441202053020033962410004440650570566056444892920
11442202063021033963410054440750572567006444992924
11443202203022033964410104440850574567406445092928
11444202253030033965410194450050575568006445592933
11446202403031033966411004500550576568106446192937
11600202453056033967411054530050580568206446392941
11601202503080133968411084530350592568216447992943
11602202513080233969411104530550593570006448392950
11603205003090133970411154530750684570206448692953
11604205013090333973412504530850686570226448792960
11606205203090533984412514530950688570236448892961
11620205253090633985412524531550690570616448992970
11621205263093033986415304531750693570656449092971
11622205273100033988418004532050694571006449392975
11623205503100233989418054532150695571056450592997
11624205513123136002418064532750951571306451093451
11626205523123336005418204533050953571356451793452
11640205533123536200418214533150955571506452093453
11641205553123736215418224533250957571556453093454
11642206003123836216418254533350961571566455393455
11643206043123936217418264533450970571606455593456
11644206053124036221418284533550972571706456193457
11646206063124136222418304533750974571806456693458
11719206103125336223418504533850976574006458593459
11720206113125436224418704534050980574106459093460
11721206123125536225420004534151100574156459593461
11730206153125636226421004534251101574206460093503
11740206503125736246421044534651102574216460593505
11750206603125936247421064534751600574526461093530
11755206653126736251421604534951605574546461193531
11760206703127636252421804535051610574556461293532
11762206973128736253421824537851700574566461593533
11765209003128836254422804537951701574606461693580
11770209023129036465422814538051702574616461793581
11900209503129136466423004538151703575006462093582
11901209743129236468423104538251705575056463093583
11920209753129336470423204538451710575106463293590
11921209793129436471423304538551715575116463393591
11950209823129536473424004538651720575136463593600
11951209833129636475424054538851725575586464093602
11952210763129736478425504538951726578006464293603
11954210853129836481426504539051727581006464493610
11976211163150036482426604539151728581206464693612
11980213103150236500427004539251729583016464793615
12001213153150536510427204539351792583216465093616
12002213203151036511428004539852000583226465393618
12004213553151136512428044552052001583236468093619
12005213563151236513428064590052005583406468193620
12006214803151336514428084590552007583456479593624
12007215503151536516428094591052010583506520593631
12011218113152036522429004591552204583536521093640
12013218123152536555429604599052214583566522093641
12014218133152636556431914602052224585556522293642
12015219203152736557431924603052234585586527093644
12016225053152836558431934605052235585596541093650
12017225103152936560431944608052240585606543093653
12018225113153036561431954608352250585616543593654
12020225133153136563431964622052260585626577893656
12021225143153536565431974622152265585636577993660
12031225263153636566431984623052270586156580093724
12032230303154036568432004632052275586616585593797
12034230313154136569432014650052276589706602093798
12035230653154536570432024650552277589746603096405
12036233303154636571432044660052281589766676196406
12037233503156036572432054660152282590006702896440
12041237003156136573432064660452283590016710196450
12042239303157036575432104660652285590126710596573
12044239313157136576432114660752287590156722196574
12045240653157236578432124660852290590206722796920
12046242003157336580432134661052300590256722896921
12047242203157436581432144661152301590306734596922
12051246403157536582432154661252305590706734697597
12052250653157636583432164661452310590726741598925
12053252463157736584432174661552315590746750098926
12054260103157836585432204670652317590766750598927
12055260113157936589432264675452318591606751598928
12056263413160036590432274690052320592006770098929
12057270403160136595432294691052325593006771098940
13100270863160336596432314691652327593206771598941
13101270933160536597432324691752330593256780098942
13120270953161236598432334692252332593506780199170
131212709631615366204323546924523345984067805G0104
131312719731622366254323646940523415984167810G0105
131322719831623366404323746942523425986667820G0121
131512725031624366604323847000523435987167825G0127
131522725631625366804323947382523446000067830G0168
150022725731626368004324047383523456010067840G0268
150042727531628368104324147490523466030067850G0276
150402732331629368154324247531523516100067875G0341
152712736931630368604324347532523526100167930G0429
152732757031631368614324447533523536102067938G0455
152752760531634369014324547534523546102668020G0460
152772760631635369024324647535523556105068040G0516
157752761331636369034324747536523566105568100G0517
157762764831638369044324847537524026107068110G0518
157862786031640369054324947538524416110768115
158242800131641369064325047539530006121068135
158252800231643371824325147540530206162368200
158262819031645371834325247541530256162468371



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.