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Modifier 25 indicates that additional reimbursement is needed to account for the extra e/m work Modifier 25, significant, separately identifiable evaluation and management (e/m) service by the same physician or other qualified healthcare professional (qhp) on the same day of the procedure or other service, is crucial for indicating distinct services performed on the same day. The key is recognizing when the additional work is “significant” and, therefore, additionally billable.
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Modifier 25 is used to indicate that a patient’s condition required a significant, separately identifiable evaluation and management (e/m) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (qhp) on the same date. It is used to report a significant, separately identifiable e/m service by the same physician on the day of a procedure. Use modifier 25 with the appropriate level of e/m service
The current procedural terminology (cpt) definition of modifier 25 is as follows
Modifier 25 significant, separately identifiable evaluation and management (e/m) by the same physician or other qualified health care professional on the same day of the procedure or other service. Administrative | commercial | november 1, 2025 modifiers 25 and 57 policy Key details and access reminders as previously communicated in an april 2024 mailing, effective july 1, 2024, the modifiers 25 and 57 Evaluation and management with global procedures reimbursement policy was renamed to modifiers 25 and 57 — professional.
Modifier 25 is used to facilitate billing of e/m services on the day of a procedure for which separate payment may be made
