Modifier 25

Information About Modifier 25 and Coding

Information and guidance regarding three extremely active payment and compliance issues:

  1. Audit requests regarding OMT services reported on the same date of service as an office visit, along with the use of the Modifier-25.
  2. Audit requests related to coding higher level Evaluation and Management (E/M) services; often linked to the increase in use of electronic health records, and;
  3. Pay-for-performance and other quality recognition programs requirements for physicians to justify any practices that may cause them to be considered practice (cost) outliers.

Downloads:

AOA Letter regarding audits and Modifier 25
AOA Position Paper: Evaluation and Management Services with OMT
CMS-Trailblazer audit tool
Medicare-Modifier 25 Use
Coding Trends of Medicare Evaluation and Management Services

US Department of Health & Human Services
Office of Inspector General report (OEI-04-10-00180)
05-08-2012