When is the modifier -25 used in relation to E/M codes?

The modifier -25 is specifically utilized to indicate that a significant, separately identifiable evaluation and management (E/M) service was performed on the same day as another procedure or service. This modifier clarifies to payers that although the E/M service occurred on the same date as another service, it was not just part of the other service and was necessary for the patient's care.

Using modifier -25 is critical when a second service is provided, ensuring that the provider can be reimbursed for the distinct E/M service rendered. It communicates that the medical necessity for the E/M service was separate from any other procedures performed that day, justifying its billing without being considered part of the bundled service. This understanding is essential for accurate coding and proper reimbursement in clinical practice.