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97001 & 97002 modifier 25 vs 59

  1. #1
    Default 97001 & 97002 modifier 25 vs 59
    Medical Coding Books
    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
    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
    Overland Park, KS
    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, CRHC, AAPC Fellow

  4. #4
    thank you dballard! those were my sentiments exactly!

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

  6. #6
    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.

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