Modifier 25 is used when E/Ms are billed with procedures that have a global day assignment because those codes have an E/M component built into them. By using the modifier, you are saying that there was more evaluation and managment done that was above and beyond and separately identifiable from the E/M of the procedure. The EKG codes don't have any global day assignment (they have XXX meaning the global day concept doesn't apply) therefore, you shouldn't need a 25 modifier.
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