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Modifier 25 with Preventive exam

  1. Default Modifier 25 with Preventive exam
    Medical Coding Books
    Has anyone heard that CMS will now longer allow a 25 modifier on an E&M code when billed with preventive service such as IPPE . If so was it a MLN Matters?

    What about other payers?

    Thanks for your input,


  2. #2
    North Carolina

    Reporting a Medically Necessary E/M Service at the Same IPPE Visit
    When the physician or qualified NPP provides a medically necessary E/M service in addition to the IPPE, CPT codes 99201 – 99215 may be used depending on the clinical appropriateness of the circumstances. CPT Modifier –25 shall be appended to the medically necessary E/M service identifying this service as a significant, separately identifiable service from the IPPE code reported (G0344 or G0402, whichever applies based on the date the IPPE is performed). NOTE: Some of the components of a medically necessary E/M service (e.g., a portion of history or physical exam portion) may have been part of the IPPE and should not be included when determining the most appropriate level of E/M service to be billed for the medically necessary E/M service.

    Chapter 12 /

    The guidance has an effective date of 1-1-09 and an implementation date of 1-5-09..

    ( – Initial Preventive Physical Examination
    (Rev. 1615, Issued: 10-17-08, Effective: 01-01-09, Implementation: 01-05-09)

    Where did your information come from?

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