Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 03.00.06q


Attachment:
A

Policy #:03.00.06q

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.
49082
49083
49084
49180
49185
49320
49321
49322
49324
49325
49400
49405
49406
49407
49411
49418
49421
49422
49423
49424
49427
49428
49429
49436
49440
3820049441
382054944262350
382064944662355
382304945062360
382324945162361
33210382424945262362
33211382434946062365
33224383004946563610
33226385005020063650
33285385055038263661
33286385105038463663
33289385705038563685
33340385715038663688
33361385725038764400
33362385735038964405
33363387905039064408
33364387925039164415
33365394015039664416
33366394025043064417
33477404905043164418
33889408005043264420
33891408015043364425
33951408045043464430
33952408055043564435
33953408065043664445
33954408085043764446
33955408105055164447
33956408125055364448
33957408205055564449
33958408305055764450
339594083150561
339624100050570
339634100550572
339644101050574
339654101950575
339664110050576
339674110550580
339684110850592
339694111050593
339704111550684
339734125050686
339844125150688
339854125250690
339864153050693
339884180050694
33989418055069592997
36002418065095193451
36005418205095393452
36200418215095593453
36215418225095793454
36216418255096193455
36217418265097093456
36221418285097293457
36222418305097493458
36223418505097693459
36224418705098093460
36225420005110093461
36226421005110193503
36246421045110293505
36247421065160093530
36251421605160593531
36252421805161093532
36253421825170093533
36254422805170193580
36465422815170293581
36466423005170393582
3646842310517056463093583
3647042320517106463293590
3647142330517156463393591
3647342400517206463593600
3647542405517256464093602
3647842550517266464293603
3648142650517276464493610
3648242660517286464693612
3650042700517296464793615
3651042720517926465093616
120013651142800520006465393618
120023651242804520016468093619
120043651342806520056468193620
120053651442808520076479593624
120063651642809520106520593631
120073652242900522046521093640
120113655542960522146522093641
120133655643191522246522293642
120143655743192522346527093644
120153655843193522356541093650
120163656043194522406543093653
120173656143195522506543593654
120183656343196522606577893656
120203656543197522656577993660
120213656643198522706580093724
120313656843200522756585593797
120323656943201522766602093798
120343657043202522776603096405
120353657143204522816676196406
120363657243205522826702896440
120373657343206522836710196450
120413657543210522856710596573
120423657643211522876722196574
120443657843212522906722796920
120453658043213523006722896921
120463658143214523016734596922
120473658243215523056734697597
120513658343216523106741598925
120523658443217523156750098926
120533658543220523176750598927
120543658943226523186751598928
120553659043227523206770098929
120563659543229523256771098940
120573659643231523276771598941
131003659743232523306780098942
131013659843233523326780199170
1312036620432355233467805G0104
1312136625432365234167810G0105
1313136640432375234267820G0121
1313236660432385234367825G0127
1315136680432395234467830G0168
1315236800432405234567840G0268
1500236810432415234667850G0276
1500436815432425235167875G0341
1504036860432435235267930G0429
1527136861432445235367938G0455
1527336901432455235468020G0460
1527536902432465235568040G0516
1527736903432475235668100 G0517
1577536904432485240268110 G0518
1577636905432495244168115
1578636906432505300068135
15824
37182
43251
53020
68200
15825
37183
43252
53025
68371
15826
Version Effective Date: 01/01/2020
Version Issued Date: 01/07/2020
Version Reissued Date: N/A

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