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New Patient Medicare Modifier -25

  1. #11
    St. Joseph County, Indiana
    Clearnace Sale
    Actually, I've seen the 'no -25 modifier for new pt visits' from my local Medicare carriers too. However, I also recall a ruling that suggested that the '57' (Decision for surgery) modifier should be used for new pt visits and '25' should be used for established pts. I've used this rule of thumb for years with few problems...or at least problems that couldn't be overturned.

    Brock Berta, CPC

  2. #12
    That would work, except that the case in the original post was a joint injection 20610. Since this procedure has less than a 90 day global period, the mod-57 should not apply.
    Walker Bachman, CPC, CPPM

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