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Modifier 25 remains one of the most scrutinized modifiers in medical billing—and one of the most misunderstood. Incorrect application can trigger payer audits, payment recoupments, refund demands, and even allegations of abusive billing patterns. Yet when used appropriately, Modifier 25 ensures providers are reimbursed accurately for medically necessary evaluation and management (E/M) services that are significant and separate from procedures and other services performed on the same day.

This comprehensive webinar will provide healthcare providers, coders, auditors, and revenue cycle leaders with clear, practical guidance on the proper reporting of Modifier 25. Attendees will learn how to distinguish between work inherent to a procedure and work that qualifies as a separately identifiable E/M service. With emphasis on documentation requirements, payer expectations, and real-world compliance risks, this session will equip participants to confidently support appropriate reimbursement while minimizing audit vulnerability.

Learning Objectives/Agenda:

• Define the CPT guidelines and payer expectations governing the appropriate use of Modifier 25.
• Distinguish between pre-procedure work bundled into a procedure and a significant, separately identifiable E/M service.
• Identify documentation elements necessary to support Modifier 25 under the E/M guidelines (Medical Decision Making and/or Time).
• Analyze common compliance pitfalls, audit triggers, and payer red flags related to Modifier 25 reporting patterns.
• Apply real-world case scenarios to determine when Modifier 25 is appropriate—and when it is not.

Why is this topic timely/important?

Modifier 25 utilization continues to be heavily monitored by Medicare Administrative Contractors (MACs), commercial payers, and the Office of Inspector General (OIG). Many practices face increasing denials, documentation requests, and post-payment audits specifically tied to same-day E/M and procedural services. As payers leverage data analytics and AI-driven audit tools, patterns of Modifier 25 reporting are more visible than ever.

Who would benefit from this webinar?

• Physicians and Non-Physician Practitioners
• Practice Administrators and Managers
• Compliance Professionals
• Revenue Cycle and Billing Leaders
• Medical Coders