What is the purpose of the modifier “-25” in medical billing?

The modifier “-25” is used in medical billing to indicate that a significant, separately identifiable service was performed on the same day as another procedure or evaluation and management (E/M) service. This helps to clarify that the healthcare provider conducted a distinct service that warranted a separate charge, even though it occurred during the same patient visit as another procedure.

For instance, if a patient comes in for a minor procedure but also requires an evaluation for a separate health issue, the provider can append the “-25” modifier to the E/M code to signify that the evaluation was significant and necessary, allowing for appropriate billing for both the procedure and the evaluation. This modifier is essential for ensuring that providers are accurately reimbursed for their work without it being bundled into the primary service.