With regards to insurance denials, I think it depends on the "claims scrubber" they use & specific payors. I have been told that McKesson's product has edits built in that automatically issue a denial when a modifier (-25) is flagged with a same DOS procedure. I also am aware of a local HMO that will not reimburse physicians on E/M procedures with a (-25). I have tried numerous levels of appeals w/ chart notes clearly showing that services were "separately identifiable" to no avail. Apparently, this caveat is written into the contract. It really is frustrating.