Wiki advanced care planning and modifier 25

[leastratton1001]

Do you append modifier to both codes when patient has advanced care planning? For example 99350 being coded along with 99497- would we append 25 to both of those CPT codes?

 

[Queizati]

Hello,

I found the following from CMS on Advance Care Planning:

These codes may be separately reported when performed on the same date of service in conjunction with the following E/M services: 99201-99215, 99217-99226, 99231-99236, 99238-99239, 99241-99245, 99251-99255, 99281-99285, 99304-99310, 99315-99316, 99318, 99324-99328, 99334-99337, 99341-99345, 99347-99350, 99381-99397, and 99495-99496. Both codes should be reported with modifier-25 added presuming the requirements for use of modifier-25 are met.

It's possible it varies by payor.