Wiki Modifier 25 or 95

[cyberenvoy1@comcast.net]

Can I use these modifiers for Medicine Management?
Ex. 99212 - 95 for Virtual visits
Ex. 99213 - 25 +90833 for Medicine management and client seen by therapist on the same day

 

[ckeeney]

In the second example 99213 - 25 +90833:
Was therapy done by the same provider? The +90833 is an add-on code to be used when the same provider does both the med management and psychotherapy; no -25 modifier is needed when it is an add-on code. If the therapy services are being billed as "incident to" under the supervising physician, I would check payer rules for billing
For example, our state Medicaid tells us to bill the therapy under the supervising provider as rendering with the appropriate provider level modifier (ex. HE or AJ) using the non-add-on therapy codes.
In this case we bill 99213 billed for the rendering provider and 90832-AJ or other therapy/modifier code combination as appropriate using the supervising provider as rendering.
We bill these on separate claims.