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Thread: G0101 with modifier 25?

  1. #1

    Default G0101 with modifier 25?

    We have documentation from a year ago indicating when billing for G0101 and Q0091, use modifier 25 on G0101 for Medicare claims. We are questioning if anyone knows if Medicare changed this to a modifier 59? Our search for information on the CMS site did not indicate that any modifier is needed. What is everyone seeing? THANKS FOR YOUR HELP!

  2. #2

    Default

    When I code for the G0101, my providers are usually doing the Well exam and so I'll have the prevent e/m code, the G0101, Q0091 and 99212-99215 if they address any of the pt's chronic or acute illnesses and then I do the carve out when sending to MCR. I always add the modifier 25 to the reg e/m and the G0101. I've not had any trouble with these not paying.

    Hope this helps
    Stephanie, CPC, HCS-D

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