Use of Modifier 25 on well visit with immunization


Local Chapter Officer
Lima, Ohio
Best answers
On Day #3 - I am questioning the use of modifier 25 on a well child visit when immunizations are given. Isn't this unbundling? Immunizations are part of wellness and not separately identifiable from a wellness visit. Insurance companies do not consider them separately identifiable and therefore most will not pay for the administration code with a wellness code.
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Yes, you bill the immunizations separate from the well-child visit, with the -25 on the visit. in fact, if you read the introduction to the Preventive Medicine Services (page 36 in the AMA Professional CPT edition), it states "Vaccine/toxoid products, immunization administrations.....are reported separately".
There are also NCCI edits for the preventive E/M codes and the vaccine administration codes.


Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC
VP, Member and Certification Development | AAPC
Direct: 801-238-9876
Thank you both for your responses. I think a lot of us are struggling with this challenge because we are working in the real world and are taking payer specifics and our own experience into account when answering the questions and not coding just based on the coding guidelines.
Liz, have you tried billing the preventative visit with a 25 modifier along with the administration codes? I don't know where you are located, but every payer I bill pays for the administration separately, even Medicaid.