Modifier -25 - know the guideline


Irmo, SC
Best answers
Could someone please let me know the guideline on -25 as far as immunizations and injections? Is that considered a seperate service? Example: If a patient comes in for an office visit and decide they want a Flu shot, DTAP, or HPV? Would you add a -25 to this?
Yes, if you are billing 90471 or 90772 you need a 25 modifier on the office visit. The drug does not bundle its the administration that bundles w/ your E&M code.
Drug Administration Services and E/M Visits Billed on Same Day of Service
Carriers must advise physicians that CPT code 99211 cannot be paid if it is billed with a drug administration service such as a chemotherapy or nonchemotherapy drug infusion code (effective January 1, 2004). This drug administration policy was expanded in the Physician Fee Schedule Final Rule, November 15, 2004, to also include a therapeutic or diagnostic injection code (effective January 1, 2005). Therefore, when a medically necessary, significant and separately identifiable E/M service (which meets a higher complexity level than CPT code 99211) is performed, in addition to one of these drug administration services, the appropriate E/M CPT code should be reported with modifier -25. Documentation should support the level of E/M service billed. For an E/M service provided on the same day, a different diagnosis is not required.