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New patients codes are exempt from -25 ?

  1. #1
    Default New patients codes are exempt from -25 ?
    Medical Coding Books

    Page 24

    Billing Tips: -25

    No supporting documentation is required with the claim when this modifier is submitted. However, the patient's medical records must contain information to support the use of modifier -25 and be available upon request. The following are the exceptions:

    o This modifier should not be submitted with E/M codes that are explicitly for new patients only: 92002, 92004, 99201-99205, 99281-99285, 99321-99323, and 99341-99345. These services are not considered part of the global surgical policy.

    Is this statement true ? And do other insurances follow these CMS guidelines ?

  2. #2
    Greeley, Colorado
    This must be carrier specific because that information is not in the TrailBlazers Modifer manual.
    Lisa Bledsoe, CPC, CPMA

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