EVALUATION/MANAGEMENT CODE MODIFIERS

EVALUATION/MANAGEMENT CODE MODIFIERS

CPT Modifier 21

Prolonged evaluation and management services - Use only with highest level of care code for the category when the face-to-face or floor/unit service provided is prolonged or otherwise greater than that usually required for the highest level code.

CPT Modifier 24

Unrelated E/M service during a post-op period - Use with E/M codes only to indicate that the E/M performed during a postoperative period for a reason(s) unrelated to the original procedure. Modifier 24 applies to unrelated E/M services for either a MAJOR or MINOR surgical procedure.
- Failure to use modifier when appropriate may result in denial of the E/M service

CPT Modifier 25

Separately identifiable service on same day as procedure - Use with E/M codes only to indicate that the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual pre- and postoperative care for the procedure performed

- Failure to use modifier when appropriate may result in denial of the E/M service

CPT Modifier 57

Decision for surgery - Use with E/M codes billed by the surgeon to indicate that the E/M service resulted in the decision for surgery (E/M visit was NOT usual pre-operative care). For E/M visits prior to MAJOR surgery (90 day post-op period) only.

- Failure to use modifier when appropriate may result in denial of the E/M service