AAPC - Back to school
Results 1 to 6 of 6

Thread: 97001 & 97002 modifier 25 vs 59

  1. #1
    Join Date
    Apr 2007

    Default 97001 & 97002 modifier 25 vs 59

    AAPC: Back to School
    We are having trouble finding documentation to support the use of modifier 25 vs 59 for a physical therapy evaluation or re-evaluation when done on the same day as therapy services which may or may not include ADLs.
    My thought process is that 25 is only for physician E&M services and shouldn't be used on therapy or other eval codes. My co-workers have been using modifier 25 and the payors are accepting the charges and paying them.
    Does anybody know where I can go to find out if 25 is actually acceptable coding practice?

    Any help or suggestions would be greatly appreciated.


  2. #2
    Join Date
    Apr 2007


    Depending on the CPT codes they probably don't need any modifier. For instance 97001 and 97116 are not bundled and there is no need for a modifier.
    Herbie W Lorona Jr., CPC, CPC-H

  3. #3


    Modifier 25 does not get apppended to these codes. This is per CPT Assistant, December 2003. Modifier 25 is only appended to E/M codes, and codes 97001/97002 are not E/M codes. If 97001/97002 are reported on the same encounter as other therapy services, then modifier 59 should be appended.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  4. #4
    Join Date
    Apr 2007


    thank you dballard! those were my sentiments exactly!

  5. #5

    Smile 97001

    Modifier 59 will not pay for your 97001, I've billed it without and got paid by Medicare

  6. #6
    Join Date
    Apr 2007


    evals do not need a modifier however if you do treatment and a re-eval 97002 or 97004 you will need a modifier -59 if you want to get paid and these can only be done every 30 days for WC.

Similar Threads

  1. 97002 w/mod 59 when coding 97110 & 97140, DENIED
    By slsowash in forum Modifiers
    Replies: 0
    Last Post: 01-23-2015, 01:57 PM
  2. Cpt code 97001 and 97002 defination
    By kumeena in forum Medical Coding General Discussion
    Replies: 9
    Last Post: 02-12-2014, 09:41 AM
  3. goal status modifier 97001
    By nadinecrowley@yahoo.com in forum Modifiers
    Replies: 0
    Last Post: 07-01-2013, 11:51 AM
  4. Billing 97001 & 96111 together
    By AKSpectrum in forum Billing/Reimbursement
    Replies: 3
    Last Post: 06-09-2011, 02:30 PM
  5. 97002
    By Eling11420 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 11-18-2009, 08:49 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.