Reimbursement Policy for Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

Policy Update

Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

(Policy 06-003, effective 04/01/2019)

 

HealthKeepers, Inc.’s Modifier 25 reimbursement policy for Anthem HealthKeepers Plus members provides the criteria for reimbursement for a significant, separately identifiable evaluation and management (E&M) service performed by the same provider on the same day of the original service or procedure. Effective September 1, 2018, HealthKeepers, Inc. does not allow separate reimbursement for E&Ms performed on the same day as a major surgery (90-day global period).

 

For additional information, refer to the Modifier 25 reimbursement policy at https://mediproviders.anthem.com/va.