June 2010
Appropriate use of Modifier -25 with chemotherapy services
Appropriate use of Modifier -25 ensures your claims are processed and paid correctly. We have identified a high volume of claims improperly appending Modifier -25 to Evaluation and Management (E&M) services when chemotherapy was administered during the same visit.
Modifier -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service is used to identify a significant, separately identifiable E&M service performed above and beyond the primary service. One situation that is frequently misunderstood occurs in describing E&M services in conjunction with chemotherapy administration.
Please review the following examples:
- Use of Modifier -25 with an E&M code is appropriate if chemotherapy is administered on the same day, by the same provider, as a separately identifiable E&M service (e.g., assessment for toxicities, care for the underlying disease, treatment for adverse effects, port access, etc.).
- Use of Modifier -25 or of an E&M code is not appropriate if chemotherapy is administered during a visit in which no separate E&M service is provided beyond those necessary for the procedure (e.g., interval history and cursory exam).
Chemotherapy administration is not the only application where an E&M code with or without Modifier -25 may be necessary.
Resources
- Review our recently added modifier information.
- View our revised online modifier workshop.