Wiki Modifier 25 with 36415

[amoore2986]

I have a question in regards to 36415 + 25 modifier. My denial manager is asking me to add the 25 modifier to 36415 for payment on Tricare claims. In all of my studies I have not seen this to be accurate. Can anyone validate this for me?

Thank you for your advice! It is very much appreciated!

 

[devinmajor14]

You cannot use modifier 25 with this code.

 

[amoore2986]

Thank you! I did not believe so, but I needed some back up!

 

[mitchellde]

Perhaps she meant you need to add a 25 modifier to the E&M code or the 36415 will not be reimbursed. And that is possibly true with tricare

 

[amoore2986]

Yes, I believe that is what she meant. Even if there is no surgical procedure? Thanks in advance for the answer.

 

[mitchellde]

It is probably because the 36415 is in the CPT section for surgical procedures and that is the way Tricare has set their edits. Anything in the CPT range of 10000-69999 is designated as surgical.

 

[amoore2986]

Thank you very much. I will try this on some claims and see what happens. I appreciate your responses. Have a wonderful day!