Information on Modifiers
Modifiers are two digit numbers which can be added to Current Procedure Terminology (CPT) codes (e.g. Evaluation and Management (E/M), Preventive Service, Procedure codes) which provide additional information about the services being provided.
MODIFIER 25:
SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE
SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE
Used when 2 separate and identifiable services with a professional component will be billed on the same day by you (or a colleague from your group). Examples of services with professional components include:
–Procedures
–E/M visits
–Preventive Visits
–Injections, immunizations
– Certain Screenings
–Tests ordered and performed on the same day for which you (or a member of your group) are the billing provider
One of the most common scenarios for the use of Modifier 25 is when a procedure is performed during an E/M visit. In these instances Modifier 25 is typically appended to the E/M service code.
Modifier 25 is added to preventive service codes when immunizations are provided.
When Billing a preventive visit and E/M visit during the same visit, the modifier 25 is appended to the E/M visit. You should document a completely separate note addressing the problem-focused E/M.
MODIFIER 50: BILATERAL PROCEDURE
Modifier 50 is appended to the procedure code CPT when the procedure performed is bilateral
MODIFIER 53: DISCONTINUED PROCEDURE
Used when a procedure is discontinued or is performed to a reduced degree (e.g. an attempted vision screen on a child who couldn't cooperate with the screen; lumbar puncture attempted but no return of CSF; operative procedure discontinued due to hypotension during sedation). The modifier is appended to the procedure CPT code.