Modifier 25 with glucose test


Kennewick, WA
Best answers
Hello All,

So our Family Practitioner did a preventive visit for a new patient (99385), and included a new patient E/M code (99201) for autism, and added a modifier 25 to the E/M code, which is correct. But then he also did a glucose blood test with a monitoring device (82962) because the patients mother was worried about the patient having diabetes because of poor eating habits, but provider confirms that the patient does not have diabetic symptoms. So the provider put a modifier 25 on the preventive visit code, stating he needs the modifier on the preventive visit for the glucose test. From what I understand, he doesn't need a modifier 25 on the preventive visit for the glucose test. Could someone please clarify if he does need the modifier on the preventive visit for the glucose test? Or if he can bill the glucose test at all?


Also our provider is putting a modifier 25 on a established patient E/M code because of the ECG he performed with interpretation (93000) for the established hypertension the patient has, "diagnosed two years ago" per chart note. The E/M portion is for CKD. Does he need the modifier 25 on the E/M code for the ECG (93000)? Can he bill for the ECG if the hypertension is a existing problem?


So I need to know if modifier 25 is appropriate for these 2 specific situations. Any feedback is appreciated!



True Blue
Local Chapter Officer
Modesto, CA
Best answers
On your first question, no a modifier is not need on the physical E&M in regards to the blood glucose test. Only the 99201 would require the use of the modifier 25.

On the second issue for the E&M and 93000. I assume that your provider is providing the interpretation and documentation of the ECG test (both the technical and professional components) if so, then the use of the modifier 25 is not a given. In some situations a carrier may reduce the payment on the 93000 to allow for the technical component only as they will consider the professional component as part of the E&M. In this case, based on the documentation and services rendered a modifier 25 may be needed to show a separate service, but in general an E&M and a 93000 are not subject to a CCI edit.

I would caution your provider to be careful with the use of modifier 25 as this is often time closely monitored and audited by many carriers and is a red flag for the OIG as well. He would want to make sure that the pro component of the ECG is truly separate from the E&M to justify the use.