Modifier 25
INFORMATION ABOUT MODIFIER 25 AND CODING (Updated September 2024)
Based on the 000-day global designation assigned to Osteopathic Manipulative Treatment (OMT) by CMS, OMT is categorized as an endoscopic or minor surgical procedure. Due to this designation, when both an Evaluation and Management (E/M) service and OMT are reported on the same date, the payment for the E/M service is typically included in the payment for the OMT. However, both CMS and the AMA CPT recognize exceptions to this rule.
CMS NCCI edits and CPT guidelines for OMT allow the reporting of an E/M service and OMT on the same date with the use of Modifier-25.
There are two key definitions for Modifier-25:
- CPT Appendix A, Modifier-25 Definition:
Modifier-25 is used when the patient’s condition requires a significant, separately identifiable E/M service, above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure performed.
- CPT OMT Guidelines:
Modifier-25 is used when the patient’s condition requires a significant, separately identifiable E/M service above and beyond the usual pre-service and post-service work associated with the procedure. The E/M service may be related to the same symptoms or condition for which the OMT was provided. Therefore, different diagnoses are not required when reporting both the OMT and E/M service on the same date.
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