jarndtx1
Contributor
Hello, has anyone have issues on where Care source are denying claim for using a modifier 25 on an E/M code when bill with another procedure? Is this new ?
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Wiki Modifier 25
- Thread starter jarndtx1
- Start date
Many payers want documentation to show that the 25 modifier was used correctly, since Modifier 25 is so frequently abused.
I'd send in documentation supporting that the E/M service was significant and separately identifiable.
Is this happening on all of your Modifier 25 claims, or is there a pattern of procedures that you see it happening with?
Here's a copy of the Caresource Modifier 25 policies effective 12/1/2022:
Caresource Ohio Medicaid: https://www.caresource.com/documents/medicaid-oh-policy-reimburse-py-1360-20221201.pdf
Caresource Marketplace plans in Ohio: https://www.caresource.com/documents/marketplace-oh-policy-reimburse-py-1363-20221201.pdf
(edited to fix link)
Caresource Ohio Medicaid: https://www.caresource.com/documents/medicaid-oh-policy-reimburse-py-1360-20221201.pdf
Caresource Marketplace plans in Ohio: https://www.caresource.com/documents/marketplace-oh-policy-reimburse-py-1363-20221201.pdf
(edited to fix link)