99395 with modifier 25

[heatherwinters]

If you bill a preventative medicine code (99395) and you did an immunization Tdap and administration, do you bill a modifier 25 on the 99395. I thought that modifier 25 was only for use on 99201-99357. Thanks

[Lisa Bledsoe]

Although one would not expect to need a modifier -25 on a preventive code, it seems that more payers are requiring it or the ancillary services won't get paid - like the immunizations. As coders, we are taught not to slap a modifier on everything, but payers won't pay if we don't. Quite a conundrum.

[LOVE2CODE]

Originally Posted by heatherwinters

If you bill a preventative medicine code (99395) and you did an immunization Tdap and administration, do you bill a modifier 25 on the 99395. I thought that modifier 25 was only for use on 99201-99357. Thanks

The answer is no....You would use modifier 25 on 99201-99357 if use on the same visit as the preventive code....


YTH, CPC

[EARREYGUE]

I would not use it, unless the claim comes back requesting a modifier, we were using mod.25 for a while on well checks with vaccines and were told we are over using mod.25 by our compliance dept.
E.A. C.P.C.

[LOVETAMBRA]

I have a patient who came in for a well woman and IUD removal, should I use the 25 modifier on the 99395?